Perioperative innate immunity and its modulation

Innate immunity plays a pivotal role in host defense. The trauma of major surgery induces a variety of immunologic alterations in patients, which can lead to subsequent increased susceptibility to postoperative infections. Surgical stress inhibits innate immunity from the time of incision until about the first postoperative day. This is an alert period with susceptibility to bacterial infections. Normal patients regain innate immunity in the first postoperative day. The absence of recovery of innate immunity may cause susceptibility to infection and eventually lead to postoperative complications. Surgical stress causes catabolism, pain, ileus, nausea and vomiting, immunosuppression, increase of cardiac demands and coagulation cascade, and pulmonary dysfunction. Perioperative treatment or remedy will affect these surgical responses. Prevention of surgical site infections (SSI) is very important for clinicians. In the past, we worked with sterilization techniques, prophylactic antibiotics and environmental support such as maintaining body temperature and supplying a high concentration of oxygen. The goal of further clinical studies must be to establish the immunomodulating property of the individual, which is very important for controlling innate immunity and inflammation in each patient. The strategy for minimizing post-surgical infections is to optimize the immune response by maintaining homeostasis through nutritional support, and to reduce the surgical trauma by using minimal invasive surgery, which consequently reduces the stress response and immunesupression.