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IMPACT OF GUT MICROBIOTA ON POSTOPERATIVE RECOVERY
AND WOUND HEALING: NEW INSIGHTS AND EMERGING
THERAPIES
João Pedro do Valle Varela1
João Pedro de Morais Siqueira2
Fernando Silva Campos3
Graziella Marques de Araújo Fernandes4
Hugo Volponi Pessoti5
Abstract: The gut microbiota, made up of trillions of microorganisms that inhabit the gastrointestinal
tract, plays a fundamental role in human health, inuencing immunological and metabolic processes
and even wound healing. Recently, studies have shown that the gut microbiota can also signicantly
impact post-operative recovery. This emerging eld of research is revealing new insights into how the
composition and function of the microbiota can aect the recovery of patients after surgery and the
eectiveness of wound healing. Understanding these interactions paves the way for the development of
innovative therapies that can improve surgical outcomes and promote faster and more ecient recovery.
This review seeks to explore the new insights into the impact of gut microbiota on postoperative
recovery and wound healing, highlighting the emerging therapies and scientic advances that are
shaping this eld. By investigating the current literature and evaluating recent clinical studies, we aim
to provide a comprehensive overview of the interactions between the microbiota and healing processes,
as well as discussing the therapeutic implications of these ndings for clinical practice. This literature
1 Metropolitan College São Carlos
2 Vila Velha University
3 Federal University of Southern Bahia
4 Vila Velha University
5 Vila Velha University
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review aims to investigate the relationship between the gut microbiota and various aspects of health
and disease, using a selected set of landmark studies. To this end, high-impact publications were
selected that address topics related to the gut microbiota, its functions, benets and implications for
human health. Post-operative recovery and wound healing are complex processes that involve a series
of biological responses, including inammation, tissue remodeling and cell regeneration. The gut
microbiota inuences these processes in a number of ways, starting with the modulation of the immune
system. Studies have shown that a healthy microbiota can promote a balanced inammatory response,
which is crucial for proper wound healing and surgical recovery. Imbalances in the microbiota, known
as dysbiosis, can lead to exacerbated or insucient inammatory responses, impairing healing and
increasing the risk of post-operative complications. The two-way communication between the gut and
other organs, known as the gut-organ axis, is fundamental to understanding how the gut microbiota
can inuence post-operative recovery. Metabolites produced by the microbiota, such as short-chain
fatty acids (SCFA), have anti-inammatory and immunomodulatory eects that can favor wound
healing. In addition, the intestinal microbiota can inuence the integrity of the intestinal barrier,
preventing bacterial translocation and consequent systemic infection, a common complication after
surgery. Based on these insights, several emerging therapies are being developed to modulate the
gut microbiota and improve post-operative outcomes. One of the promising approaches is the use of
probiotics and prebiotics. Probiotics are live microorganisms that, when administered in adequate
amounts, confer health benets on the host, while prebiotics are substrates that promote the growth
and activity of benecial bacteria in the gut. Clinical studies have shown that supplementation with
specic probiotics can reduce the incidence of post-operative infections and improve wound healing.
Another innovative approach is fecal microbiota transplantation (FMT), which involves transferring
microbiota from a healthy donor to a patient with dysbiosis. FMT has shown promising results in
restoring the intestinal microbiota and improving post-operative outcomes in patients undergoing
major surgery. In addition, diet and nutrition play a crucial role in modulating the microbiota. Diets
rich in ber and bioactive compounds, such as polyphenols, can promote a healthy microbiota and
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consequently improve postoperative recovery and wound healing. It is concluded that the impact
of gut microbiota on postoperative recovery and wound healing is a rapidly evolving eld of
research with signicant potential to transform clinical practices. New insights are revealing how
the microbiota inuences inammatory and immunological processes essential for surgical recovery.
Emerging therapies, such as probiotics, prebiotics and fecal microbiota transplantation, are showing
promising results in improving postoperative outcomes. Modulation of the gut microbiota represents
an innovative and eective approach to optimizing patient recovery and promoting faster and more
ecient healing. With further research and the integration of this knowledge into clinical practice,
it is hoped that microbiota intestinal becomes a key component in post-operative management and
wound care, signicantly improving patients’ quality of life.
Keywords: Intestinal Microbiota; Postoperative; General Surgery; Gastroenterology; Innovative
Therapies.
INTRODUCTION
The intestinal microbiota, made up of trillions of microorganisms, plays a key role in
maintaining human health and regulating various physiological processes. In recent years, research
has highlighted the inuence of intestinal microbiota on immune response and postoperative recovery.
Microbiota diversity and balance are essential for the health of the immune system, which, in turn,
is crucial for wound healing and recovery after surgery. Studies show that a healthy microbiome
can improve immune response, reduce inammation and accelerate tissue recovery (Sommer and
Bäckhed, 2013).
In addition, intestinal microbiota can directly inuence wound healing through metabolites
production that modulate inammatory response and promote tissue regeneration. Interaction between
the intestinal microbiota and the immune system may favor an environment conducive to eective
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healing. Research indicates that dysbiosis, or microbiota imbalance, can compromise inammatory
response and slow the healing process, making microbioma modulation a potential strategy to improve
postoperative results (CH and Blaser, 2012).
New emerging therapies, such as the use of probiotics, prebiotics and fecal microbiota
transplants, have shown signicant promises in intestinal microbiota modulation to optimize
postoperative recovery and wound healing. Probiotics, for example, can restore microbial balance and
strengthen immunological defenses, while prebiotics provide substrates for the growth of benecial
microorganisms. Fecal microbiota transplantation, although still in early research stages, has a
remarkable potential to restore microbial homeostasis in patients with severe dysbiosis, improving
clinical results (Suez et al., 2019).
Given these new insights, it is crucial to continue exploring the complex interactions between
the intestinal microbiota and postoperative recovery, as well as develop and implement therapies
that can eectively modulate microbiota. The in -depth understanding of these mechanisms can
revolutionize current treatment approaches, providing better results for patients in terms of wound
healing and global recovery (ZUO & NG, 2018).
MATERIALS AND METHODS
This bibliographic review aims to investigate the relationship between the intestinal
microbiota and various aspects of health and disease, using a selected set of reference studies. To
this end, high impact publications have been selected that address topics related to the intestinal
microbiota, its functions, benets and implications on human health. The adopted methodology
followed the following steps:
1. Selection of sources: The references were chosen based on the relevance and impact on the
eld of intestinal microbiology. Selected publications include pairs revised and published in renowned
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scientic journals such as Nature Reviews Microbiology, Nature Reviews Genetics, Frontiers in
Microbiology, New England Journal of Medicine, among others.
2. Inclusion Criteria: Articles that address:
• The development and physiology of the host inuenced by the intestinal microbiota
(Sommer & Bäckhed, 2013).
• The interface between human microbiome and health/disease (Cho & Blaser, 2012).
• The pros and cons of the use of probiotics (Suez et al., 2019).
• The role of microbiota in pathogenesis and therapy of intestinal inammatory diseases
(Zuo & NG, 2018).
• The inuence of microbiota on surgical recovery (Krezalek et al., 2016).
• Denitions and eects of probiotics, prebiotics and symbiotics (Schrezenmeir & de
Vrese, 2001).
• Bacterial metabolites and colorectal cancer (Louis et al., 2014).
• Use of donor feces infusion to treat recurrent closetridium dicile (Van Nood et al.,
2013).
• General Benets of Probiotics (Ouwehand et al., 2002).
• Clinical trials on probiotic prophylaxis in severe acute pancreatitis (BESSELINK et al.,
2008).
• Impact of intestinal microbiota on brain and behavior (CRYAN & DINAN, 2012).
• Evolution of the concept of sepsis of intestinal origin (DEITCH, 2012).
• Mechanisms and health benets of ber and prebiotics (Slavin, 2013).
3. Review of Articles: Each article has been thoroughly revised to extract relevant information
on the intestinal microbiota, its functions, and its implications on human health. The information has
been organized thematically to facilitate comparative analysis and data synthesis.
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4. Summary of results: Extracted information was synthesized to provide a comprehensive
view of the role of intestinal microbiota in health and disease, highlighting the main ndings of each
study and identifying areas of consensus and controversy in the current literature.
5. Critical discussion: The results were critically discussed in light of available evidence,
considering the limitations of revised studies and the implications for future research and clinical
practices.
THEORETICAL FOUNDATION
The relationship between the intestinal microbiota and postoperative recovery is an emerging
research area that has generated great interest in the scientic community. Studies show that microbiota
plays a crucial role in modulation of the immune system, which is critical to recovery after surgery.
A balanced microbiota contributes to an adequate immune response that helps prevent infections and
promote wound healing. For example, patients with a diverse microbiota have a faster recovery and
fewer postoperative complications (KREAZALEK et al., 2016).
Intestinal dysbiosis, or imbalance in microbiota composition, has been associated with an
increased risk of infections and slower wound healing. The presence of pathogenic bacteria and the
reduction of benecial bacteria may compromise the integrity of the intestinal barrier, leading to an
exacerbated and prolonged inammatory response. Clinical studies have shown that interventions to
restore microbiota balance, such as the use of probiotics and prebiotics, can improve postoperative
results. For example, the administration of probiotics in surgical patients was associated with a
signicant reduction in infection rates and an improvement in wound healing (Schrezenmeir & de
Vrese, 2001).
In addition, metabolites produced by intestinal microbiota, such as short chain fatty acids
(AGCC), play a vital role in regulating inammatory response and promoting tissue regeneration.
AGCC, such as butirato, have anti-inammatory properties and can promote the proliferation and
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dierentiation of epithelial cells, facilitating wound healing. Dietary ber supplementation, which are
fermented by Microbiota to produce AGCC, has shown improved healing in experimental models.
This suggests that dietary interventions that modify intestinal microbiota can be an eective strategy
for improving postoperative recovery (Louis et al., 2014).
Fecal microbiota transplantation (TMF) is an emerging approach that has shown promises
to restore microbial homeostasis in patients with severe dysbiosis. TMF involves the transfer of
microbiota from a healthy donor to a patient’s gastrointestinal tract, with the aim of restoring a healthy
microbiome. Preliminary studies indicate that TMF can be eective in improving wound healing
and reducing postoperative complications, especially in patients with antibiotic resistant infections.
Although still in the experimental phase, the TMF can become a valuable tool in postoperative
recovery management (Van Nood et al., 2013).
Interrelation between intestinal microbiota and wound healing is an expanding eld, with
research indicating that microbiota can directly inuence tissue repair processes. The presence
of a diverse and balanced microbiota is associated with an optimized immune response, which is
essential for ecient healing. On the other hand, an imbalance in microbiota, or dysbiosis, can lead
to a prolonged inammatory response, compromising tissue regeneration and increasing the risk of
infections. Interventions that restore microbial equilibrium have shown to be eective in accelerating
wound healing and improving postoperative results (DEITCH, 2012).
The role of probiotics in intestinal microbiota modulation to promote wound healing has
been widely studied. Probiotics, which are benecial living microorganisms, can compete with
pathogens by resources and space, inhibiting the growth of harmful bacteria and modulating the
immune response. Clinical studies have shown that probiotic administration can reduce inammation,
promote the production of anti-inammatory cytokines and accelerate wound healing. For example, a
study showed that patients who received probiotics after abdominal surgery had a faster recovery and
lower incidence of infectious complications (BESELINK et al., 2008).
Prebiotics, which are non -digestible dietary bers that feed benecial bacteria in the gut,
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also play a crucial role in intestinal health and wound healing. Ingestion of prebiotics can increase
the production of short chain fatty acids (AGCC), such as butirato, which have anti-inammatory
properties and promote the integrity of the intestinal barrier. Prebiotic supplementation has been
associated with an improvement in intestinal microbiota composition and an increase in AgCC
production, which can accelerate wound healing and reduce inammation (Slavin, 2013).
Moreover, the interaction between the intestinal microbiota and the enteric nervous system,
known as the intestine-brain axis, can inuence postoperative recovery and wound healing. Microbiota
can produce neurotransmitters and other metabolites that modulate the function of the enteric nervous
system, aecting gastrointestinal motility and inammatory response. Studies indicate that modulation
of the intestine-brain axis through microbiota interventions can improve response to surgical stress
and promote wound healing (Cryan & Dinan, 2012).
Finally, the combination of therapeutic approaches, including the use of probiotics, prebiotics
and TMF, can oer an integrated strategy for the modulation of intestinal microbiota and the
improvement of postoperative results. The customization of these interventions based on the patient’s
individual microbiota prole can maximize therapeutic benets and minimize risks. As research
advances, understanding of complex interactions between intestinal microbiota and wound healing
will continue to evolve, oering new opportunities for innovative clinical interventions (Ouwehand
et al., 2002).
CONCLUSION
Therefore, the understanding of the crucial role that the intestinal microbiota plays in
postoperative recovery and wound healing has opened new borders in the eld of medicine and post-
surgical therapy. Studies show that the composition and functionality of intestinal microbiota are
closely linked to modulation of inammatory response, maintenance of intestinal barrier integrity,
and the production of bioactive metabolites that promote tissue regeneration.
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Interventions that aim to restore and optimize microbiota, such as the use of probiotics,
prebiotics and fecal microbiota transplantation, have shown promising in several studies, indicating
that these strategies can reduce postoperative complications and signicantly improve healing
outcomes. In addition, diet modulation, emphasizing ber consumption and fermented foods, also
presents itself as an eective approach to maintaining a healthy and functional intestinal microbiome.
These ndings highlight the importance of an integrated approach to postoperative
management, where intestinal health is considered a fundamental component of patient recovery. The
personalization of interventions, based on the individual composition of microbiota, can represent a
signicant advance in personalized medicine, optimizing results and minimizing the risks associated
with surgeries.
However, it is necessary to continue research to fully understand the mechanisms by which
the intestinal microbiota inuences wound healing and postoperative recovery. Warmer and more
well -controlled clinical studies are essential to validating proposed interventions and establishing
standardized therapeutic protocols.
In conclusion, the intestinal microbiota emerges as an important ally in promoting
postoperative health and wound healing. Emerging therapies aimed at modulation of microbiota
represent a promising eld that can transform current clinical practices, oering patients a faster and
more eective recovery. Integration of advanced knowledge of microbiota into therapeutic strategies
can redene postoperative care, signicantly improving the quality of life of surgical patients.
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