Surgical manipulation of the large intestine increases bacterial translocation in patients undergoing elective colorectal surgery.
OBJECTIVE
Several animal studies have suggested that surgical manipulation of the intestine alters the barrier function and promotes bacterial translocation (BT). Whether this occurs in humans has never been investigated. The aim of this study was to determine the effect of surgical manipulation of the intestine on the prevalence of BT in patients undergoing elective colorectal surgery.


METHODS
This was a prospective observational study of 50 consecutive elective surgical patients in whom a sample of mesenteric lymph node (MLN) was harvested after mobilization of the colon, prior to ligation of the vascular pedicle. These results were compared with 472 historical controls, who had a sample of MLN taken before the mobilization of colon during laparotomy. A positive culture of MLN confirmed BT.


RESULTS
BT was identified in 39/49 (79.6%) patients in the study group compared with 54/472 (11.4%) patients in the control group. This difference was statistically significant (P < 0.001, chi(2) test).


CONCLUSIONS
Surgical manipulation of the bowel does increase the prevalence of BT and therefore is associated with changes in gut barrier function in elective surgical patients.
Reddy
B S
BS
Combined Gastroenterology Research Unit, Scarborough Hospital, Scarborough, UK.
Gatt
M
M
Sowdi
R
R
MacFie
J
J
D000368:Aged; D001424:Bacterial Infections / Q000276:immunology / Q000517:prevention & control; D018988:Bacterial Translocation; D015179:Colorectal Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000276:immunology / Q000382:microbiology*; D008198:Lymph Nodes / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology* / Q000517:prevention & control; D011446:Prospective Studies