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Table 1 Preclinical and translational studies investigating the role of GM in determining AL

From: The gut microbiota and colorectal surgery outcomes: facts or hype? A narrative review

Author (year) Sample size Population Group/groups Outcomes Results Main findings/hypothesis
(1955) [1]
14 cases Dogs 1. 8 dogs -antibiotic at the site of anastomosis and orally (achromycin)
2. 6 dogs – no topical antibiotics
Bowel viability after
colic anastomoses with devascularization
1. 75% dogs had viable colon
2. 100% dogs in the control group died after ischemic perforation
Topic antibiotics help maintaining viability of the ischemic bowel and allow for regeneration
(1963) [2]
44 cases Mice 1. Germ-free mice (24 cases)
2. Conventional mice (20 cases)
Status of the ileal mucosa and lamina propria 1. Lamina propria poor of vessels, lymphocites and mononuclear cells; small Peyer’s patches with low mitotic activity; thin mucosal layer
2. Lamina propria rich of lymphocites, mononuclear and plasma cells; well-represented Peyer’s patches with high mitotic activity; well-represented mucosal layer
GM promotes the trophism of the ileal mucosa
(1994) [3]
57 cases Mice 1. Pseudomonas inoculation
2. Controls
3. Decontaminated
AL (esophagojejunal anastomosis) AL rate:
1. 95%
2. 80%
3. 6%
Bacteria could play a major role in the pathogenesis of AL following gastrectomy
(1999) [4]
49 cases Mice 1. Germ-free,
2. Conventional
3. monocontamina
ted with Lacto- bacillus acidophilus La5
4. Escherichia coli X7
5. ex-germ-free (repopulated)
Anastomotic healing
(ileum and colon)
2. and 5. had higher anastomotic bursting pressure both in the ileum and in the colon compared with the other groups The establishment of a normal intestinal flora restores the healing capacity of the anastomosis
(2013) [5]
NA Drosophila larvae, Mice Germ-free drosophilia colonized with 6 different bacteria (3 g + and 3 g-);
Germ-free wild-type mice vs Nox-1 deficient mice feeded with L. rhamnosus and E. Coli
Response of gut epithelia to different bacteria Drosophilia’s gut colonized by L. Plantarum shows increased niche cells proliferation.;
Germ-free WT mice feeded with L. Rhamnosus have an increased ROS production in the small intestine
Lactobacillus induces ROS production
Bacteria-induced ROS production promotes epithelial proliferation and intestinal barrier functions
Van Praagh
(2016) [6]
16 cases Human tissue (donuts from colorectal surgery) 1. Patients who developed AL
2. Patients without AL
AL Lachnospiraceae family in GM found on the doughnuts is significantly higher in the AL group Correlation between Lachnospiraceae, BMI and anastomotic leak
Van Praagh
(2019) [7]
123 cases Human tissue (donuts from colorectal surgery) 1. Patients who developed AL
2. Patients without AL
3. Patients treated with C-seal
4. Patients not treated with C-seal
AL 3. High AL rates. No association between AL and GM
4. AL linked with low microbial diversity, high level of Bacteroidaceae and Lachnospiraceae families
Low microbial diversity of GM is linked with AL in patients not treated with C-Seal