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The Microbiome-Host Interaction as a Potential Driver of Anastomotic Leak

  • Victoria M. GershuniEmail author
  • Elliot S. Friedman
Nutrition and Obesity (S McClave, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Nutrition and Obesity

Abstract

Purpose of Review

The goal of this paper is to review current literature on the gut microbiome within the context of host response to surgery and subsequent risk of developing complications, particularly anastomotic leak. We provide background on the relationship between host and gut microbiota with description of the role of the intestinal mucus layer as an important regulator of host health.

Recent Findings

Despite improvements in surgical technique and adherence to the tenets of creating a tension-free anastomosis with adequate blood flow, the surgical community has been unable to decrease rates of anastomotic leak using the current paradigm. Rather than adhere to empirical strategies of decontamination, it is imperative to focus on the interaction between the human host and the gut microbiota that live within us. The gut microbiome has been found to play a potential role in development of post-operative complications, including but not limited to anastomotic leak. Evidence suggests that peri-operative interventions may have a role in instigating or mitigating the impact of the gut microbiota via disruption of the protective mucus layer, use of multiple medications, and activation of virulence factors.

Summary

The microbiome plays a potential role in the development of surgical complications and can be modulated by peri-operative interventions. As such, further research into this relationship is urgently needed.

Keywords

Microbiome Microbiota Anastomotic leak Anastomosis Surgical site infection Colorectal surgery Gastrointestinal surgery General surgery Mechanical bowel prep 

Notes

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Department of Surgery, Perelman School of MedicineHospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Division of Gastroenterology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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