Probiotics and fecal microbiota transplantation in surgical disorders

The importance of the gut microbiota in health and disease has led to interest in developing methods to modify it. Probiotics administration and fecal microbiota transplantation (FMT) are two such approaches that can alter the gut microbiota, potentially offering health benefits by blocking gut colonization by pathogenic organisms and preventing a maladaptive immune response. Both methods have been studied in a variety of settings relevant to colorectal surgeons, including colorectal cancer, inflammatory bowel disease, Clostridium difficile colitis, and surgical site infections. However, both therapies offer risks and benefits in surgical patients. Probiotics allow for targeted alterations of the microbiome, but lingering questions remain regarding strain selection. FMT offers to more completely restore the healthy gut microbial ecosystem but it is difficult to study in animals and to determine its precise mechanism of action. Standardizing study methodologies and using modern molecular and genetic techniques to elucidate the mechanisms of action will be needed to determine the role of probiotic administration and FMT in treating or preventing complications in patients undergoing major abdominal surgery.