Society for Surgery of the Alimentary Tract
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Lucas Fair*, Steven G. Leeds, Brittany Buckmaster, Sarah Wheeler, Bola Aladegbami, Marc Ward
Surgery, Baylor University Medical Center at Dallas, Dallas, TX

Leaks of the gastrointestinal tract are a devastating complication that can occur after foregut operations. It has been suggested that the pathogenesis of foregut leaks is directly influenced by the gut microbiome. The purpose of this study was to evaluate the composition of the microbiome within and between patients with gastrointestinal leaks to better understand the pathogenesis of these leaks.

Patients undergoing interventions for gastrointestinal leaks from October 2021 to October 2022 were included in this study. During endoscopic and surgical interventions for gastrointestinal leaks, both microbial and host samples were collected. Genomic DNA of microbial samples were extracted and amplified. PCR products were sequenced using Illumina Nextera protocol. Effective sequence of bacterial 16S-rRNA gene was clustered into OTUs for analysis.

A total of 196 samples were collected from 16 patients (13 females; 3 males) with 49 samples used for the 16S analysis. The majority (56.2%) of patients required multiple interventions for their leaks, while a smaller portion (43.8%) underwent a single intervention. 42/49 samples (85.7%) included in the 16S analysis were from patients requiring multiple interventions with a mean of 4.6 interventions performed per patient in this group. In the entire cohort, Firmicutes was consistently the most abundant bacteria present. For patients that required multiple interventions, the microorganism composition changed over the course of treatment. At the index procedure, Firmicutes and Actinobacteria were on average the most abundant phyla present. By the end of treatment, Firmicutes remained dominant. However, abundances of Bacteroidetes and Proteobacteria increased, and the abundance of Actinobacteria decreased. Notably, there was a significant reduction in the Firmicutes to Bacteroidetes ratio by the end of treatment. In one patient who was not progressing well clinically, they were noted to have an increase in their Firmicutes to Bacteroidetes ratio and a much higher abundance of Proteobacteria when compared to other patients.

In conclusion, data from our study indicates that the Firmicutes to Bacteroidetes ratio of the gut microbiome significantly changed throughout the treatment of gastrointestinal leaks. A better understanding of this ratio and its role in gastrointestinal leaks could allow for more effective prevention and treatment strategies.

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