Perioperative Endotoxemia and Bacterial Translocation during Major Surgery

Abstract

The passage of viable indigenous bacteria and/or constituents of their cell wall, i.e. endotoxins, from the gastrointestinal tract to extraintestinal organs, has been implicated in the pathogenesis of sepsis, the multiple-organ dysfunction syndrome and death. Unfortunately, these conditions are extremely frequent and carry high mortality rates in surgical patients. In terms of morbidity and mortality, we have compelling evidence from laboratory work in experimental animals indicating the importance of bacteria and endotoxin translocation. In humans, however, the clinical significance of translocation is still a point of debate. This paper focuses on perioperative endotoxemia and bacterial translocation in humans.