• Jasper B van Praagh, Marcus C de Goffau, Ilsalien S Bakker, Harry van Goor, Hermie J M Harmsen, Peter Olinga, and Klaas Havenga.
• Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
• Ann. Surg. 2019 May 1; 269 (5): 911-916.

ObjectiveThe aim of the present study is to investigate the association of gut microbiota, depending on treatment method, with the development of colorectal anastomotic leakage (AL).BackgroundAL is a major cause for morbidity and mortality after colorectal surgery, but the mechanism behind this complication still is not fully understood.MethodsBacterial DNA was isolated from 123 "donuts" of patients where a stapled colorectal anastomosis was made and was analyzed using 16S MiSeq sequencing. In 63 patients, this anastomosis was covered with a C-seal, a bioresorbable sheath stapled to the anastomosis.ResultsIn non-C-seal patients, AL development was associated with low microbial diversity (P = 0.002) and correspondingly with a high abundance of the dominant Bacteroidaceae and Lachnospiraceae families (P = 0.008 and 0.010, respectively). In C-seal samples, where AL rates were slightly higher (25% vs 17%), an association with the gut microbiota composition was almost undetectable. Only a few opportunistic pathogenic groups of low abundance were associated with AL in C-seal patients, in particular Prevotella oralis (P = 0.007).ConclusionsAL in patients without a C-seal can be linked to the intestinal microbiota, in particular with a low microbial diversity and a higher abundance of especially mucin-degrading members of the Bacteroidaceae and Lachnospiraceae families. In C-seal patients, however, it seems that any potential protective benefits or harmful consequences of the gut microbiota composition in regard to wound healing are negated, as progression to AL is independent of the initially dominant bacterial composition.

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