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Updated: Sep 13, 2025
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Effect of Preoperative Bowel Preparation and Diet on Anastomotic Healing and the Colon Microbiota: An Experimental
Kaan Sunter1, Aysegul Binay2, Mustafa A Turhan1
1Department of General Surgery, School of Medicine, Ankara University, Ankara, Turkey.
Introduction:
Intestinal microbiota members, particularly Enterococcus faecalis, play significant roles in the pathogenesis of anastomotic leaks (ALs), with key mechanisms involving collagenase production and matrix metalloproteinase-9 (MMP-9) activation. Diet strongly affects microbiota composition, with Western diets (WDs) promoting dysbiosis, which may exacerbate AL. The effects of mechanical bowel preparation (MBP) and oral antibiotics on AL remain unclear. This experimental study explored the impact of preoperative diet and MBP on AL, focusing on the intestinal microbiota.
Methods:
Sixty-four female Wistar albino rats were fed a WD or standard diet (SD) for 3 weeks before surgery. The rats were subsequently divided into subgroups according to MBP or oral antibiotic administration. Enterococcus colonies were analyzed throughout the procedure, and their correlation with AL was evaluated by assessing collagenase activity and MMP-9 tissue concentrations.
Results:
Enterococcus colony collagenase activity was significantly greater in the WD group than in the SD group (P = 0.024). Moreover, anastomotic burst pressures were nonsignificantly lower in the WD group. Finally, MMP-9 levels and collagenase activity were significantly lower in the groups that received either diet with oral antibiotics and MBP than in other subgroups (P = 0.045 and P = 0.007, respectively).
Conclusions:
An SD, especially combined with MBP and oral antibiotics, plays a critical role in reducing the risk of AL by modulating collagenase activity in E faecalis and MMP-9 tissue concentrations in rats. Thus, dietary interventions may improve surgical outcomes; however, further clinical studies are necessary to validate these results in human populations.
Insights
A standard diet combined with mechanical bowel preparation and oral antibiotics significantly reduces the risk of anastomotic leaks (ALs) by modulating collagenase activity in Enterococcus faecalis and matrix metalloproteinase-9 (MMP-9) levels.
Area of Science:
- Surgical research
- Microbiology
- Gastroenterology
Background:
- Intestinal microbiota, particularly Enterococcus faecalis, contributes to anastomotic leaks (ALs) through collagenase production and MMP-9 activation.
- Western diets (WDs) can promote dysbiosis, potentially worsening AL, while the impact of mechanical bowel preparation (MBP) and oral antibiotics is unclear.
Purpose of the Study:
- To investigate the effects of preoperative diet and MBP on AL in a rat model.
- To analyze the impact on intestinal microbiota, specifically Enterococcus colonies, collagenase activity, and MMP-9 levels.
Main Methods:
- Sixty-four female Wistar albino rats were fed a WD or standard diet (SD) for 3 weeks.
- Subgroups received MBP or oral antibiotics.
- Enterococcus colonies, collagenase activity, and MMP-9 tissue concentrations were analyzed and correlated with AL.
Main Results:
- Enterococcus collagenase activity was significantly higher in the WD group compared to the SD group (P=0.024).
- MMP-9 levels and collagenase activity were significantly lower in groups receiving SD with oral antibiotics and MBP (P=0.045 and P=0.007, respectively).
Conclusions:
- A standard diet, particularly when combined with MBP and oral antibiotics, is crucial in mitigating AL risk.
- Dietary interventions show promise for improving surgical outcomes, warranting further clinical investigation.
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