Postoperative changes of the microbiome: are surgical complications related to the gut flora? A systematic review

BMC Surg. 2017 Dec 4;17(1):125. doi: 10.1186/s12893-017-0325-8.


Background: The purpose of this review was to identify the relationship between the gut microbiome and the development of postoperative complications like anastomotic leakage or a wound infection. Recent reviews focusing on underlying molecular biology suggested that postoperative complications might be influenced by the patients' gut flora. Therefore, a review focusing on the available clinical data is needed.

Methods: In January 2017 a systematic search was carried out in Medline and WebOfScience to identify all clinical studies, which investigated postoperative complications after gastrointestinal surgery in relation to the microbiome of the gut.

Results: Of 337 results 10 studies were included into this analysis after checking for eligibility. In total, the studies comprised 677 patients. All studies reported a postoperative change of the gut flora. In five studies the amount of bacteria decreased to different degrees after surgery, but only one study found a significant reduction. Surgical procedures tended to result in an increase of potentially pathogenic bacteria and a decrease of Lactobacilli and Bifidobacteria. The rate of infectious complications was lower in patients treated with probiotics/symbiotics compared to control groups without a clear relation to the systemic inflammatory response. The treatment with synbiotics/probiotics in addition resulted in faster recovery of bowel movement and a lower rate of postoperative diarrhea and abdominal cramping.

Conclusions: There might be a relationship between the gut flora and the development of postoperative complications. Due to methodological shortcomings of the included studies and uncontrolled bias/confounding factors there remains a high level of uncertainty.

Keywords: Anastomotic leakage; Gastrointestinal microbiome; Microbiota; Postoperative complications; Surgical wound infection.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Digestive System Surgical Procedures / adverse effects*
  • Gastrointestinal Microbiome*
  • Humans
  • Postoperative Complications / epidemiology*
  • Postoperative Period
  • Probiotics / therapeutic use
  • Wound Infection / epidemiology