Peri-operative modulation in gastro-intestinal surgery

SUMMARY In the last century and a half, current gastro-intestinal surgery could be developed because of the arrival of general anesthesia, antiseptic measurements, sutures, staplers and laparoscopic surgery. This thesis focuses on two large areas of surgical involvement; colorectal cancer and metabolic surgery. Colorectal cancer is currently one of the most common malignancies and one of the leading causes of cancer related mortality. A radical and oncological complete resection is a crucial factor in prognosis.(1) In a response to the rising epidemic of morbid obesity, metabolic surgery has increased as an important treatment option. Despite numerous technical and perioperative improvements, complication rates in gastrointestinal surgery are still considerable, affecting quality of life, hospital stay, oncological outcome and costs. The postoperative immune response is considered necessary for wound and intestinal healing, but an exaggerated response is also a potential cause of complications. Postoperative infection rates are higher in colorectal resections than in gastric and small bowel surgery because of manipulation of the large intestine, where bacteria are most abundant. The studies described in this thesis aim to investigate potential methods to beneficially influence the postoperative immune response and clinical outcomes in gastro-intestinal surgery: the enhanced recovery after surgery (ERAS) protocol (part 1), the administration of intravenous omega-3 fatty acids in colon cancer surgery (part 2) and the administration of oral omega-3 fatty acids in gastric bypass surgery (part 3).