Intestinal microbiota and anastomotic leakage of stapled colorectal anastomoses: a pilot study.

Jasper B van Praagh, Marcus C de Goffau, Ilsalien S Bakker, Hermie J Harmsen, Peter Olinga, Klaas Havenga. University Medical Center Groningen, University of Groningen

Introduction – Anastomotic leakage (AL) after colorectal surgery may lead to morbidity, reinterventions, prolonged hospital stay and even death. The cause of AL may for example be a poorly constructed anastomosis, tension between the afferent and efferent loop, insufficient circulation, or incomplete doughnuts. Patient related factors as diabetes or corticosteroid use can compromise the healing of the anastomosis. In many cases, however, there seems to be no explanation for the occurrence of AL. The intestinal microbiome is recently suggested to play a role in wound healing, diabetes and Crohn’s disease. The aim of this study is to determine and compare the intestinal microbiota of patients who developed AL with matched patients with healed colorectal anastomoses.

Methods – We investigated the microbiome in doughnuts we collected from patients that participated in the C-seal trial. Eight patients who developed AL requiring reintervention were selected, matched with eight control patients without AL. We analysed the bacterial 16S rDNA of both groups with MiSeq sequencing. PANDAseq, QIIME and ARB software was used to analyse the received data. Statistical analyses on the family, genus and species level were performed. Principal component analysis (PCA) was used to find clusters of similar groups of samples or species. A hierarchical clustering analysis was performed and microbial diversity was determined.

Results – A higher abundance of bacteria from the Lachnospiraceae family (P = 0.001) and a lower microbial diversity (P = 0.037) was found in the AL group compared to the no AL group. Body mass index (BMI) was also positively associated with the abundance of the Lachnospiraceae family (P = 0.022). AL was associated with a high score on principle component 1 and/or a low microbial diversity.

Conclusion – The bacterial family Lachnospiraceae, low microbial diversity and anastomotic leakage were correlated with the development of AL, possibly in association with the BMI. The relative abundance of the Lachnospiraceae family is counterintuitive as most of the bacteria from this family are not particularly known to have a negative influence on the bowel. We will expand this study with an analysis of all available doughnuts and correlated patient data from the C-seal trial.

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