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EFFECT OF PREOPERATIVE SELECTIVE DECONTAMINATION OF THE DIGESTIVE TRACT (SDD) AND MECHANICAL BOWEL PREPARATION (MBP) ON POSTOPERATIVE ILEUS IN MICE Lisa Hartmann*, Benedikt Nölle, Mario H. Müller, Nina Hering, Martin E. Kreis Department of Surgery, Charité University Medicine Berlin, Berlin, Germany Introduction: Preoperative selective decontamination of the digestive tract (SDD) to eliminate gram-negative bacteria seems advantageous for perioperative morbidity and nosocomial infections in colorectal surgery. Combined preoperative mechanical bowel preparation (MBP) with SDD may reduce postoperative ileus (POI) in patients. The aim of the present study was to determine whether intestinal permeability and leukocyte infiltration of the intestinal wall decrease during SDD and/or MBP in POI in mice. Methods: C57BL/6 mice were orally gavaged twice daily with SDD-solution during three consecutive days. Controls received 0.9% NaCl instead of SDD-solution. On the fourth day both groups were anesthetized (ketanest/xylazin i.p.). After a mini-laparotomy, intestinal lavage with 0.9% NaCl (simulating MBP) was performed and POI was induced by standardized manipulation of the small intestine. Controls received induction of POI by standardized manipulation only. Permeability measurements of fluorescein (132 Da) were performed in Ussing chambers at 1, 3 and 9 hours after surgery in different subgroups (n=7 each). In addition leukocyte infiltration of the intestinal wall was evaluated by myeloperoxidase (MPO) staining at the same timepoints. Results: One hour after induction of POI permeability in groups with MBP (SDD+MBP and NaCl+MBP) was 4.3×10-6 cm/s ± 0.8 and 5.6×10-6 cm/s ± 0.8 which was significantly lower compared to 8.6×10-6 cm/s ± 1.1 in POI-controls without intervention (p=0.01). There were no differences in leukocyte infiltration of the intestinal wall in all three groups. At three hours permeability was 4.5×10-6 cm/s ± 0.6 and 5.7×10-6 cm/s ± 1.0 in MBP-animals (SDD+MBP and NaCl+MBP) and 8.5×10-6 cm/s ± 0.6 in POI-controls (p<0.05). MPO stains showed a reduced leukocyte infiltration in MBP-animals (NaCl+MBP) compared to POI-controls at three and 9 hours (144.6 ± 8.2 cells/area vs. 174.1 ± 7.4 cells/area; p<0.05 and 141.8 ± 14.8 cells/area vs. 197.0 ± 11.9 cells/area; p<0.02). No difference was observed in permeability measurements 9 hours after induction of POI when comparing SDD/MBP and POI-controls. Conclusions: Mechanical bowel preparation with or without SDD reduces permeability and leukocyte infiltration of the intestinal wall in the early phase of postoperative ileus in mice. This may entail a subsequently quicker recovery of intestinal motility.
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