title: Intestinal microbiota and anastomotic leakage of stapled colorectal anastomoses: a pilot study.
abstract: Anastomotic leakage (AL) after colorectal surgery is a severe complication, resulting in morbidity, reinterventions, prolonged hospital stay and, in some cases, death. Some technical and patient-related aetiological factors of AL are well established. In many cases, however, none of these factors seem to explain the occurrence of AL. Recent studies suggest that the intestinal microbiome plays a role in wound healing, diabetes and Crohn's disease. The aim of this study was to compare the intestinal microbiota of patients who developed AL with matched patients with healed colorectal anastomoses.
  
  
  
  We investigated the microbiome in the doughnuts collected from 16 patients participating in the C-seal trial. We selected eight patients who developed AL requiring reintervention and eight matched controls without AL. We analysed the bacterial 16S rDNA of both groups with MiSeq sequencing.
  
  
  
  The abundance of Lachnospiraceae is statistically higher (P = 0.001) in patient group who did develop AL, while microbial diversity levels were higher in the group who did not develop AL (P = 0.037). Body mass index (BMI) was also positively associated with the abundance of the Lachnospiraceae family (P = 0.022).
  
  
  
  A correlation between the bacterial family Lachnospiraceae, low microbial diversity and anastomotic leakage, possibly in association with the BMI, was found. The relative abundance of the Lachnospiraceae family is possibly explained by the higher abundance of mucin-degrading Ruminococci within that family in AL cases (P = 0.011) as is similarly the case in IBD.
authors.affiliation: Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands. j.b.van.praagh@umcg.nl.
authors.forename: Jasper B
authors.initials: JB
authors.lastname: van Praagh
authors.affiliation: Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Marcus C
authors.initials: MC
authors.lastname: de Goffau
authors.affiliation: Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
authors.forename: Ilsalien S
authors.initials: IS
authors.lastname: Bakker
authors.affiliation: Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Hermie J M
authors.initials: HJ
authors.lastname: Harmsen
authors.affiliation: Pharmaceutical Technology and Biopharmacy, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Olinga
authors.affiliation: Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
authors.forename: Klaas
authors.initials: K
authors.lastname: Havenga
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology / Q000382:microbiology*; D001419:Bacteria / Q000302:isolation & purification; D016022:Case-Control Studies; D003106:Colon / Q000382:microbiology* / Q000601:surgery; D003107:Colorectal Surgery / Q000009:adverse effects*; D005260:Female; D000069196:Gastrointestinal Microbiome; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000382:microbiology*; D012007:Rectum / Q000382:microbiology* / Q000601:surgery
keywords: Anastomotic leakage; Colorectal surgery; Complications; DNA sequencing; Intestinal microbiome; Stapled anastomosis