Low-fat/high-fibre diet prehabilitation improves anastomotic healing via the microbiome: an experimental model

Abstract

Background: Both obesity and the presence of collagenolytic bacterial strains (Enterococcus faecalis) can increase the risk of anastomotic leak. The aim of this study was to determine whether mice chronically fed a high-fat Western-type diet (WD) develop anastomotic leak in association with altered microbiota, and whether this can be mitigated by a short course of standard chow diet (SD; low fat/high fibre) before surgery.Methods: Male C57BL/6 mice were assigned to either SD or an obesogenic WD for 6 weeks followed by preoperative antibiotics and colonic anastomosis. Microbiota were analysed longitudinally after operation and correlated with healing using an established anastomotic healing score. In reiterative experiments, mice fed a WD for 6 weeks were exposed to a SD for 2, 4 and 6 days before colonic surgery, and anastomotic healing and colonic microbiota analysed.Results: Compared with SD-fed mice, WD-fed mice demonstrated an increased risk of anastomotic leak, with a bloom in the abundance of Enterococcus in lumen and expelled stool (65-90 per cent for WD versus 4-15 per cent for SD; P = 0⋅010 for lumen, P = 0⋅013 for stool). Microbiota of SD-fed mice, but not those fed WD, were restored to their preoperative composition after surgery. Anastomotic healing was significantly improved when WD-fed mice were exposed to a SD diet for 2 days before antibiotics and surgery (P < 0⋅001).

The Association of Gut Microbiota and Complications in Gastrointestinal-Cancer Therapies

“…Enterococcus faecalis is associated with an increased rate of anastomosis insufficiency, and second-and thirdgeneration cephalosporins failed to eradicate E. faecalis from anastomotic tissue [54]. In addition, there was a positive effect on anastomosis healing by a low-fat/high-fibre diet in a murine model, which was attributed, among other things, to an improved diversity of the intestinal microbiome [55]. The positive effect of SCFAs was also demonstrated in animal models.…”

Progress in the esophagogastric anastomosis and the challenges of minimally invasive thoracoscopic surgery

“…A prospective study on 55 esophagectomy patients found a significantly greater variance in the microbiome diversity in oral and gastric samples of patients who had a leak compared to those without leaks (22). Also, a recent study found that lowfat/high fiber diet prehabilitation can reverse the adverse effect of a high-fat diet on anastomotic healing in mice by restoring the Bacteroidetes in the colonic lumen (23). If confirmed in larger studies, this may suggest that the oral and upper gastrointestinal microbiome are implicated in the pathogenesis of anastomotic leakage, and that manipulation of microbiome may possibly be used in the future to decrease the incidence of anastomotic leakage.…”

Comparative genetics of Enterococcus faecalis intestinal tissue isolates before and after surgery in a rat model of colon anastomosis

“…Given the numerous deletions, insertions and polymorphic regions between genomes in lower collagenolytic potential pre-op isolates and higher collagenolytic post-op isolates, it can be inferred that isolates represent distinct populations colonizing colonic tissues during surgery vs many days following surgery when present on a healing anastomotic wound. The high rate of colonization by collagenolytic strains that we previously observed on healing anastomotic wound several days after surgery [10,35,36] suggests that the healing anastomotic environment is a preferable niche for collagenolytic strains. Initial strains present on normal colonic tissue might represent a population of E. faecalis with varying levels of collagenolytic activity.…”