Surgical manipulation of the large intestine increases bacterial translocation in patients undergoing elective colorectal surgery

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Abstract
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. 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. 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). 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.