Background: Gastrointestinal surgery is still associated with a relevant morbidity with the intestinal microbiome being of high importance in the pathogenesis of infectious complications. Various approaches, such as mechanical bowel preparation (MBP) with or without administration of oral antibiotics, fasting or dietary supplements aim at modulating the intestinal flora.
Objective: This review summarizes the current literature pertinent to the influence of preoperative bowel conditioning on postoperative morbidity.
Material and methods: A literature search was performed using the mentioned keywords with a focus on recent meta-analyses.
Results and conclusion: Bowel conditioning reduces postoperative infectious complications. Promising approaches are MBP plus administration of oral antibiotics, dietary supplements aiming at stabilization of the intestinal flora as well as the screening for and equilibration of malnutrition. The use of MBP as monotherapy without antibiotics should no longer be considered part of the clinical routine.
Keywords: Immunonutrition; Intestinal microbiome; Mechanical bowel preparation; Metabolic conditioning; Oral antibiotics.