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Präoperative Konditionierung des Darms

  • A.‑K. Eichelmann
  • A. PascherEmail author
Leitthema

Zusammenfassung

Hintergrund

Gastrointestinale Eingriffe sind nach wie vor mit einer relevanten Morbiditätsrate assoziiert, wobei dem intestinalen Mikrobiom eine zentrale Bedeutung in der Pathogenese infektiöser Komplikationen zukommt. Dabei lässt sich die Darmflora präoperativ durch verschiedene Ansätze wie die mechanische Darmreinigung mit oder ohne Gabe oraler Antibiotika, Fasten oder Nahrungsergänzungsmittel modulieren.

Fragestellung

Der Übersichtsartikel beleuchtet die Frage, inwiefern eine präoperative Konditionierung des Darms das postoperative Morbiditätsrisiko senken kann.

Material und Methoden

Literaturrecherche mit den u. g. Schlüsselworten und Screening von Literaturverzeichnissen im Zeitraum nach 2010 mit Schwerpunkt auf aktuelle Metaanalysen.

Ergebnisse und Schlussfolgerung

Durch eine präoperative Konditionierung lässt sich die Inzidenz infektiöser Komplikationen senken. Vielversprechende Ansätze liegen in der mechanischen Darmspülung in Kombination mit der Gabe oraler Antibiotika sowie Maßnahmen, die eine Stabilisierung der Darmbarriere anstreben, sowie dem Screening und Ausgleichen einer Malnutrition. Die Darmspülung als Monotherapie hat ihre Berechtigung verloren.

Schlüsselwörter

Mechanische Darmreinigung Orale Antibiotika Metabolische Konditionierung Intestinales Mikrobiom Immunonutrition 

Abkürzungen

ACS-NSQIP

American College of Surgeons National Surgical Quality Improvement Program

BMI

Body-Mass-Index

CD

Clostridium difficile

DGAV

Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie

ERAS

Enhanced recovery after surgery

ESPEN

European Society for Clinical Nutrition and Metabolism

FMT

Fäkaler Mikrobiomtransfer

i.v.

Intravenös

IN

Immunonutrition

MBP

Mechanical bowel preparation, mechanische Darmreinigung

NRS

Nutritional Risk Screening

OA

Orale Antibiotika

OR

Odds Ratio

RCT

Randomized controlled trial

WHO

World Health Organization

Preoperative bowel conditioning

Abstract

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

Mechanical bowel preparation Oral antibiotics Metabolic conditioning Intestinal microbiome Immunonutrition 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A.-K. Eichelmann und A. Pascher geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Allgemein‑, Viszeral- und TransplantationschirurgieUniversitätsklinikum MünsterMünsterDeutschland

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