Microbiome research will revolutionize how the bowel is prepared for surgery, lecturer says

John C. Alverdy, MD, FACS
John C. Alverdy, MD, FACS

Microbiome research is rapidly advancing our understanding of the mechanisms that underpin surgical infection and wound healing, with findings that will soon be applied to the practice of gastrointestinal surgery. This next-generation technology will affect almost everything surgeons do, according to John C. Alverdy, MD, FACS, the Sarah and Harold Lincoln Thompson Professor of Surgery and executive vice-chair of surgery at the University of Chicago, IL.

Dr. Alverdy will explore the rapidly expanding science of the intestinal microbiome Monday during the annual I.S. Ravdin Lecture in the Basic and Surgical Sciences, Microbiome Medicine: This Changes Everything.

“Microbiome sciences are going to revolutionize the way surgeons prepare the intestinal tract for surgery,” Dr. Alverdy said. “Although we do a pretty good job of preventing infection through the use of intestinal cleansing with purgatives, nothing by mouth after midnight, and oral and intravenous antibiotics, the scientific basis of these practices is incomplete and outdated. We could do much better if we were to apply next-generation technology to understand how the microbiome is affected before, during, and after surgery. Compelling evidence is emerging that how we use antibiotics, how we feed patients, how we treat wounds, and how we prepare patients prior to major surgery can be refined in ways not previously understood.”

Microbiome research suggests that many of the practices used to prepare the bowel for surgery are intrinsically flawed and can lead to superinfections like Clostridium difficile colitis, Dr. Alverdy said. Fecal transplantation, first described in the U.S. by Ben Eiseman, MD, and his surgeon colleagues, is emerging as the most effective treatment for this problem. And some of the most common surgical complications—ileus, sepsis syndrome, wound infections, adhesions, cancer recurrence, and anastomotic leak—have been directly linked to the microbiome.

Researchers also have demonstrated that the effects of the microbiome extend beyond the gut, Dr. Alverdy added. And while years of research is beginning to unravel the role of human genetics in cancer and other diseases, there are far more microbiome genes than human genes. Unraveling the genetics of the microbiome and its effects on health and disease throughout the body is a logical extension of today’s research efforts.

For all stakeholders involved in surgery—surgeons, hospital administrators, insurers, and regulatory bodies—readmission rates are the new proxy for quality. And the two most common reasons for readmission are infection and ileus. Dr. Alverdy will review the mechanisms of these persistent problems and provide practical and deliverable approaches to prevention. He will also demonstrate how the pillars of the Enhanced Recovery After Surgery program can promote rapid recovery of the microbiome after surgery.

“It’s now possible to develop programs that reshape and enhance a patient’s microbiome before you operate in order to give the patient every opportunity to counteract the physiologic stress of surgery with enhanced resilience and improved outcomes,” Dr. Alverdy said.

This annual lecture has been sponsored by the I.S. Ravdin Surgical Society since 1964 to honor Dr. Ravdin by promoting knowledge in basic sciences with application to surgery.