V. M. Gershuni1,2, G. D. Wu2, R. R. Kelz1 1Hospital Of The University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA 2Hospital Of The University Of Pennsylvania,Division Of Gastroenterology,Philadelphia, PA, USA
Introduction:
Composed of numerous bacteria, their genes, and bioactive metabolites, the gut microbiome is a significant contributor to overall health and disease. The gut microbiome plays a critical role in mucosal integrity and inflammation. The microbiome is an attractive target to modify surgical outcomes. The purpose of this review was to describe current knowledge on the relationship between the gut microbiome and GI surgical outcomes.
Methods:
Using defined search terms, an exploratory literature review was performed in PubMed and Google Scholar (January 1, 2012 to July 31, 2017) to identify articles on the gut microbiome and GI surgical outcomes, specifically including anastomotic leak (AL) and surgical site infection (SSI). After title and abstract review, articles were selected for data abstraction based on discussion amongst the co-authors. Data was not abstracted from review articles although primary sources were examined. The following study characteristics were recorded: article type, human or animal study, number of study subjects, scientific methods and outcomes.
Results:
Among 384 references identified, the majority (n=344) were not related to GI surgery and one article was a retrospective study of surgical outcomes. A total of 39 articles reported on aspects of the microbiome and GI surgical outcomes. Twenty-five articles specifically examined anastomotic leak and surgical site infection. Eighteen of the 39 were literature reviews (including one systematic and one meta-analysis), 13 studies reported primary data from animal models, and four reported primary data in human subjects. A summary of the findings from human studies can be seen in the Table. Animal data suggests that the microbiota may play an integral role in the host response to surgical injury.
Conclusion:
Evidence on the association between the host-microbiome and GI surgical outcomes is limited in humans. Preliminary evidence suggests that the gut microbiota balance may be disturbed in patients who experience anastomotic leak and SSI. Further studies focused on the relationship between the microbiome and these outcomes may allow us to curtail the morbidity and mortality associated with GI surgery. Some of the interesting potential targets for perioperative intervention include non-absorbable oral antibiotic use, local delivery of phosphate-based therapy, and exploration into the mechanism of refaunation after microbiome disturbance.
