Bacterial translocation, and intestinal permeability in patients undergoing open or laparoscopic total colectomy.
- open, right side or left side first laparoscopically -

Background: Postoperative infectious complications such as pneumonia, sepsis, abscess, urinary tract infection, and cholangitis are mainly caused by the patient’s own gut flora probably due to bacterial translocation. Bacterial translocation describes the passage of bacteria from the gastrointestinal tract to normally sterile tissues such as the mesenteric lymph nodes and other internal organs.
Objectives: To assess whether bacterial translocation occurs during laparoscopic total colectomy compared to open colectomy, and to determine whether the order of devascularisation matters with respect to bacterial translocation, and intestinal permeability.
Hypothesis: We hypothesise that bacterial translocation is the least in open colectomy followed by laparoscopic colectomy starting the devascularisation on the left side followed by laparoscopic colectomy starting the devascularisation on the right side.
The longer period of devascularisation results in an increased permeability and higher risk of bacterial translocation.
Patients and Methods: A total of 30 patients who are planned to undergo an open or laparoscopic total colectomy for inflammatory bowel diseases or familial adenomatous polyposis from AMC Amsterdam will be included in this study. After informed consent, patients that are planned to undergo a laparoscopic operation will be randomly assigned to 2 groups (right or left side first) using sealed envelopes. A third group will be a control group consisting of patients undergoing an open operation. Study parameters will be a) the concentration of polyethylene glycol (PEG) in the urine, b) the concentration of intestinal fatty acid binding protein (IFABP-c) in the urine, c) collection of mesenteric lymph nodes from the distal ileum and d) distal ileum full-thickness biopsies from the surgical resection specimen.

We hypothesise that bacterial translocation is the least in open colectomy followed by laparoscopic colectomy starting the devascularisation on the left side followed by laparoscopic colectomy starting the devascularisation on the right side.
The longer period of devascularisation results in an increased permeability and higher risk of bacterial translocation.

Devascularisation beginning left or right in case of laparoscopice colectomy. In case of open colectomy mobilization from lateral to medial