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The gut microbiota and gastrointestinal surgery

Key Points

  • Under normal conditions the intestinal microbiota provide resistance to pathogens

  • The physiological stress of surgical injury on the gastrointestinal tract can result in a profound shift in gut microbiota abundance, function and spatial location

  • Postsurgical re-establishment of the intestinal microbiota population is poorly understood

  • Selective pressures due to the process of surgical care can promote the development of resistant pathogens

  • Major intestinal reconstruction alters the intestinal microbiota; the altered microbiota might contribute to some of the benefits of these procedures, but could also contribute to the development of postsurgical complications

  • The effects of surgical injury can, in some cases, result in an in vivo transformation of intestinal bacteria to a more virulent phenotype

Abstract

Surgery involving the gastrointestinal tract continues to prove challenging because of the persistence of unpredictable complications such as anastomotic leakage and life-threatening infections. Removal of diseased intestinal segments results in substantial catabolic stress and might require complex reconstructive surgery to maintain the functional continuity of the intestinal tract. As gastrointestinal surgery necessarily involves a breach of an epithelial barrier colonized by microorganisms, preoperative intestinal antisepsis is used to reduce infection-related complications. The current approach to intestinal antisepsis varies widely across institutions and countries with little understanding of its mechanism of action, effect on the gut microbiota and overall efficacy. Many of the current approaches to intestinal antisepsis before gastrointestinal surgery run counter to emerging concepts of intestinal microbiota contributing to immune function and recovery from injury. Here, we review evidence outlining the role of gut microbiota in recovery from gastrointestinal surgery, particularly in the development of infections and anastomotic leak. To make surgery safer and further reduce complications, a molecular, genetic and functional understanding of the response of the gastrointestinal tract to alterations in its microbiota is needed. Methods can then be developed to preserve the health-promoting functions of the microbiota while at the same time suppressing their harmful effects.

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Figure 1: The effect of perioperative events on the intestinal microbiota.
Figure 2: Host–microorganism communication.
Figure 3: Altering anatomy alters the physiology and microenvironment of the intestine.
Figure 4: Microbial pathogenesis of anastomotic leak: context-dependent virulence expression in response to cues released by surgically injured tissues.

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Guyton, K., Alverdy, J. The gut microbiota and gastrointestinal surgery. Nat Rev Gastroenterol Hepatol 14, 43–54 (2017). https://doi.org/10.1038/nrgastro.2016.139

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