Influence of the intestinal microbiome on anastomotic healing in the colon and rectum

Colonic and rectal anastomotic leak has long plagued the surgeons, without much improvement despite decades of advances in suture technique and technology. At the intersection of microbiotal changes in flux via a combination of environmental factors and the virulent pathology of the organisms colonizing the gastrointestinal tract, lies an underappreciated mechanism and thus possible solution for anastomotic failure. Through preoperative preparation, intraoperative manipulation, and postoperative management, the flora is constantly changing. This article explores the shifts in composition and expression of the digestive flora in response to external factors and the effects thus far observed on anastomotic healing, as well as proposed therapeutic strategies given the leading theories on microbiotal pathogenesis of anastomotic leak.