Gut microbiome, surgical complications and probiotics

Abstract

The trigger for infectious complications in patients following major abdominal operations is classically attributed to endogenous enteral bacterial translocation, due to the critical condition of the gut. Today, extensive gut microbiome analysis has enabled us to understand that almost all “evidence-based” surgical or medical intervention (antibiotics, bowel preparation, opioids, deprivation of nutrition), in addition to stress-released hormones, could affect the relative abundance and diversity of the enteral microbiome, allowing harmful bacteria to proliferate in the place of depressed beneficial species. Furthermore, these bacteria, after tight sensing of host stress and its consequent humoral alterations, can and do switch their virulence accordingly, towards invasion of the host. Probiotics are the exogenously given, beneficial clusters of live bacteria that, upon digestion, seem to succeed in partially restoring the distorted microbial diversity, thus reducing the infectious complications occurring in surgical and critically ill patients. This review presents the latest data on the interrelationship between the gut microbiome and the occurrence of complications after colon surgery, and the efficacy of probiotics as therapeutic instruments for changing the bacterial imbalance.

The effect of enteral nutrition in colorectal surgery

“…3 Third, several confounders were identified that may have affected the effect of myopenia on inflammatory markers. However, our data and other literature 37,38 do not support a strong effect of sex or ASA grade on the postoperative inflammatory response. The surgical approach (open versus laparoscopic), setting (acute versus elective), and degree of surgical trauma may also affect the magnitude of the surgical inflammatory response.…”

“…18,34 Modulation of the surgical stress response -development of Enhanced Recovery Protocols Several perioperative elements contribute to the magnitude of the surgical stress response, including degree of surgical trauma, fasting, and bed rest. 18,[35][36][37][38][39][40][41][42] To improve outcomes and minimize surgical stress, the multimodal Enhanced Recovery After Surgery (ERAS) protocols were introduced. 43-46 These protocols include for example carbohydrate loading, minimally invasive surgical techniques, early postoperative mobilization, and early oral feeding.…”

A new ex vivo model for optimizing distribution of therapeutic aerosols: the (inverted) bovine urinary bladder

“…For example, small bowel serosa -which permits bacterial translocation [10] -might be much more permeable to macromolecules than the gastric serosa. Thus, evaluation of the influence of technical factors on homogeneity of aerosol distribution in vivo might be biased by organ-specific factors [7].…”

Non‐obstetric abdominal surgery during pregnancy and birth outcomes: A Danish registry‐based cohort study

“…The need for surgery and choice of procedure must balance maternal and fetal safety. Surgical procedures trigger both inflammatory and microbial responses, which may affect the fetus and timing of birth . The risk of adverse birth outcomes after surgery during pregnancy has been the topic of several studies .…”