Antibiotics | Study on Factors Affecting Postoperative Gut Microbiome Recovery

This study systematically evaluates the impact of perioperative factors (surgical procedures, bowel preparation, and antibiotic use) on gut microbiome recovery, focusing on microbial diversity and functional changes within six months post-operation, providing theoretical foundations for optimizing postoperative management strategies.

 

Literature Overview
The article "The Role of Surgical and Perioperative Factors in Shaping Gut Microbiome Recovery After Colorectal Surgery", published in the journal Antibiotics, reviews and synthesizes how surgical approaches, perioperative interventions, and baseline diseases (e.g., diverticulitis and colorectal cancer) influence gut microbiome recovery. By longitudinally collecting fecal samples at multiple timepoints pre- and post-operation, the study analyzes long-term effects of surgical stress and antibiotic interventions on microbiome composition and functionality (e.g., short-chain fatty acid levels).

Background Knowledge
The gut microbiome plays a critical role in postoperative recovery, with its alterations strongly linked to complications such as anastomotic leakage and surgical site infections. Short-chain fatty acids (SCFAs), key metabolic products of gut microbiota, are essential for maintaining intestinal barrier integrity and immune regulation. Surgical stress, mechanical bowel preparation (MBP), and oral antibiotics (OAs) significantly disrupt microbial community structures, while distinct baseline diseases (e.g., diverticulitis versus colorectal cancer) may influence recovery trajectories. The relative impacts of surgical approaches (e.g., resection versus non-resection) and baseline diseases on microbial recovery remain unclear, limiting optimization of perioperative intervention strategies. By comparing different surgical cohorts, this study addresses this knowledge gap and provides potential directions for personalized clinical interventions.

 

 

Research Methods and Experiments
The study enrolled 81 patients undergoing colonoscopy (n=30), non-resection surgery (n=25), or segmental resection with primary anastomosis (n=26). Longitudinal fecal samples were collected preoperatively, intraoperatively, and at 10, 30, and 180 days post-operation. 16S rRNA sequencing analyzed microbial diversity, while SCFA levels were quantified to assess functional changes. Subgroup analyses stratified by baseline diseases (diverticulitis versus cancer) and surgical location (right versus left colectomy) evaluated differential recovery patterns.

Key Conclusions and Perspectives

• Microbial α-diversity recovered by postoperative day 10 in colonoscopy patients, but required up to day 180 for both non-resection and resection cohorts. β-diversity analysis indicated incomplete microbial community restoration in resection patients.
• Within 30 postoperative days, resection patients exhibited significant enrichment of Streptococcus and Enterococcus alongside decreased SCFA levels, suggesting greater functional impairment.
• Diverticulitis patients showed delayed early-stage beneficial microbiota recovery, while cancer patients demonstrated more stable recolonization potentially due to reduced preoperative antibiotic exposure.
• Samples from patients with postoperative complications (e.g., anastomotic leakage) revealed minimal microbial similarity to non-leakage controls, requiring validation in larger cohorts due to limited sample size.

Research Significance and Prospects
This study highlights the profound influence of perioperative interventions (particularly bowel preparation and antibiotics) on gut microbial recovery, demonstrating that surgical approaches and baseline disease status significantly modify recovery trajectories. Future research should investigate personalized bowel preparation protocols and microbiome-supportive strategies to enhance postoperative healing and reduce infection risks. Integrating multi-omics approaches to characterize microbial functional pathways will facilitate development of targeted interventions.

 

 

Conclusion
This study elucidates how perioperative interventions, surgical approaches, and baseline diseases affect gut microbiome recovery. Resection surgeries cause greater microbiome disruption, with reduced SCFA levels potentially impairing postoperative healing. Differential recovery patterns between cancer and diverticulitis patients suggest that personalized perioperative management could improve microbial restoration. Future studies should employ larger cohorts and multi-omics integration to establish causal relationships between microbial recovery and postoperative complications, and develop microbiome-targeted interventions.

 

Julia Kohn, Alexander Troester, Zachary Ziegert, Christopher Staley, and Wolfgang B Gaertner. The Role of Surgical and Perioperative Factors in Shaping Gut Microbiome Recovery After Colorectal Surgery. Antibiotics.