Low-fat/high-fibre diet prehabilitation improves anastomotic healing via the microbiome: an experimental model.

Background: Colon has the highest risk of anastomotic leakage and increases 2.5-fold in peritonitis. To prevent leakage of colonic anastomosis, there are some modalities to upgrade the quality of wound healing. The mineral zinc is good for healing intestinal anastomotic wounds and vitamin C, whose function is related to wound healing and maintaining vascular integrity. This study investigated the effect of daily zinc and vitamin C supplementing on rabbits with peritonitis who underwent colonic anastomosis. Material and methods: Thirty-six New Zealand rabbits underwent peritonitis 5 hours after they continued with a laparotomy to wash the abdominal cavity and colonic anastomosis. The rabbits were then divided into 2 groups. First group was given zinc and vitamin C syrup, while the second group was given normal saline without zinc and vitamin C. On the 6-day postoperative, the rabbits were terminated, and tissue was collected at the colonic anastomosis to examine the histological score of anastomotic wound healing. Results: Significant differences in anastomotic healing in terms of histological scores (collagen density α=0.00, p<0.05; Neovascularisation α=0.00, p<0.05; Fibroblasts, α=0.00, p<0.05). This study generally explains the relationship between zinc and vitamin C administration and colonic anastomosis wound healing in peritonitis. Conclusion: There were significant differences in histological wound healing scores (collagen density, neovascularization, fibroblasts) in the treatment group compared to the control group.

Previous experimental studies have repeatedly demonstrated the potential protective effect of remote ischemic preconditioning (IPC) on colon anastomosis. The purpose of this experimental study was to investigate the possible positive effects of IPC by interval insufflations in laparoscopic colon operations. Thirty Wistar-albino rats were randomized into 3 groups. Colonic transsection and anastomosis were performed in the control group. In the laparoscopic colon operation without IPC group, the intra-abdominal pressure was raised to 14 mm Hg for 60 minutes, and then laparotomy and colonic anastomosis were performed. In the IPC group, the intra-abdominal pressure was raised to 14 mm Hg for 5 minutes, followed by desufflation. Laparotomy and colonic anastomosis were performed exactly as in the non-IPC group. On the seventh postoperative day, all animals were killed, and blood and tissue samples were obtained. Anastomotic healing and inflammatory responses were determined by histopathologic examination and by measuring the anastomotic bursting pressure, tissue hydroxyproline level, and tissue and serum nitric oxide, malondialdehyde (MDA), and catalase activity levels. Differences with P-values of <0.05 were considered to be statistically significant. Although the best anastomotic healing was detected in the control group, anastomotic healing was better in the IPC group than that in the non-IPC group. In terms of anastomotic bursting pressure, plasma MDA, serum catalase activity, and tissue nitric oxide levels, the IPC group was superior to the non-IPC group. No significant differences were found between the control and IPC groups, except in the plasma MDA levels. Use of IPC with colon anastomosis had positive effects on wound healing and may serve as a safe method to reduce the adverse effects of ischemia and wound healing in laparoscopic colon operations.

Background: It is now well established that microbes play a key and causative role in the pathogenesis of anastomotic leak. Yet, in patients, determining whether a cultured pathogen retrieved from an anastomotic leak site is a cause or a consequence of the complication remains a challenge. The aim of this study was to test a methodology to invoke causality between a retrieved microbe from a leak site and its role in anastomotic leak. Methods: The commensal organism Bacillus subtilis was isolated from an esophagojejunostomy leak site in a 35-year-old patient with a CDH1 mutation after a prophylactic gastrectomy whose body mass index (BMI) was 35 kg/m2. The organism was screened for its ability to degrade collagen, shift human recombinant matrix metalloprotease-9 (MMP9) to its active form, and induce a clinical anastomotic leak when introduced to anastomotic tissues of mice fed their standard diet (SD) of chow or an obesogenic Western-type diet (WD). Results: The Bacillus subtilis strain retrieved from the anastomotic leak site displayed a high degree of collagenolytic activity and was able to activate human MMP9 consistent with other pathogens expressing this characteristic "leak phenotype." Exposure of the Bacillus subtilis to the anastomotic tissues of obese mice fed a WD led to dehiscence of the anastomosis, abscess formation with peritonitis, and mortality in 50% of mice (3/6). When anastomotic healing was evaluated by a validated anastomotic healing score (AHS), substantially worse healing was observed (i.e., higher AHS) in WD-fed mice exposed to Bacillus subtilis compared to SD-fed mice (analysis of variance [ANOVA], p = 0.0006). Conclusions: Microbial strains obtained from patients' anastomotic leak sites can be evaluated for their pathogenic in the leak process by assessing their ability to produce collagenase, activate MMP9 and cause clinical leaks in mice fed a WD. These studies may aid in identifying those bacterial strains that play a causal role in patients with an anastomotic leak.

Colon anastomosis is frequently performed in surgery. Tissue growth factors, adequate perfusion, and surgical technique are the factors affecting anastomotic healing. The platelet-rich plasma (PRP) is important in tissue healing because it includes various growth factors. The aim of this study is to determine the effects of platelet rich plasma on anastomotic healing both in normal colonic anastomosis or in the presence of peritonitis. Fifty-six rats were randomized into the following 5 groups: X, PRP preparation group; A, normal colonic anastomosis group; B, PRP-treated colonic anastomosis group; C, colonic anastomosis in the group with peritonitis; and D, PRP-treated colonic anastomosis in the group with peritonitis. In the surgical procedure, platelet rich plasma anastomosis was performed in groups C and D. Rats were sacrificed in postoperative day 5. Anastomosis bursting pressure, tissue hydroxyproline levels, and histopathologic healing in anastomotic lines were evaluated. No anastomotic leak was observed. No statistically significant differences were observed in anastomotic burst pressure or tissue hydroxyproline levels between groups. In histopathologic evaluation, collagen amount, epithelialization, fibroblastic activity, and neovascularization statistically significant differences were observed in PRP-treated groups. In this study, we have shown that platelet-rich plasma treatment increases anastomotic healing and it can safely be used in colonic anastomosis.

Analgesic regimes to avoid opioid-related adverse effects have been recommended in gastrointestinal surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) are an important component of opioid sparing regimes in that these drugs indirectly reduce pain by inhibiting inflammation. Although beneficial for most surgical patients, animal studies and recent clinical studies suggest a harmful effect on new intestinal anastomoses by increasing the rate of leakage. NSAIDs may indirectly disturb anastomotic healing by inhibiting inflammation as an integrated part of the wound healing process in an early, critical phase after surgery. A literature review based on a structured search in PubMed of clinical and experimental studies investigating the effects of NSAIDs on anastomotic healing and leakage rates after intestinal surgery, as well as proposed mechanisms and effects studied in animal models. Three recent observational cohort studies (accumulated n = 882) indicate an increased rate of anastomotic leakages (15-21%) associated with cyclooxygenase-2 (COX-2) selective NSAIDs after intestinal surgery compared to the leakage rates in controls or historical cohorts (1-4%). Three prospective studies on related topics contain relevant data on NSAIDs and are compared to these studies. Several experimental animal studies support an increased risk for anastomotic leakage with the use of NSAIDs. The reported effects of NSAIDs on anastomotic healing suggest an increased risk for leakage. A better understanding of the complex interactions of NSAID-induced inhibition on anastomotic healing is a prerequisite for the safe use of NSAIDs. Until more data are available, a careful use of NSAIDs may be warranted in gastrointestinal anastomotic surgery.

Introduction: Resveratrol (RSV) is a natural polyphenolic compound found in grape skins and the red wine which improves histological reorganization of the regenerating tissue in dermal wound healing. Since anastomotic healing possesses paramount importance to prevent complications in colorectal surgery, the present study is aimed to evaluate the effect of RSV on the healing of experimental left colonic anastomoses. Methods: Thirty-two male Wistar albino rats were randomized into two groups and subjected to colonic anastomosis. The study group was treated with RSV and the control group received tap water instead. The rats were sacrificed 3 and 7 days postoperatively. Wound complications, intra-abdominal abscesses, and anastomotic leaks and stenosis were recorded. Four types of assessment were performed: bursting pressure, hydroxyproline (OHP) content, histopathology, and biochemical analysis. Results: Compared to the control group, the RSV-treated rats displayed a higher bursting pressure (p <. 001) and anastomotic OHP content (p <. 05)]. RSV treatment leads to significant increase in PON activity at both time points and decrease in malondialdehyde levels on postoperative day 3 (p <. 001). Histopathological analysis revealed that RSV administration leads to a better anastomotic healing in terms of mucosal ischemia, neovascularization, reepithelialization, fibroblast, and lymphocyte infiltration. Conclusion: The study results suggest that exogenous RSV administration exerts a positive effect on experimental colonic wound healing in the rat. Although the precise cellular mechanisms by which RSV enhances anastomotic wound healing is not clear, stimulation of neovascularization, generation of collagen synthesis, inhibition of overinflammation, and restriction of oxidative injury seems to be of paramount importance.

<h3>Background</h3> The standard of care of colorectal cancer (CRC) management consists of surgical resection of the colon or rectum, followed by a reconnection, or ‘anastomosis’, of the remaining bowel ends to re-establish gastrointestinal continuity. Up to 30% of patients may present poor healing of the anastomosis, and anastomotic leak (AL), a major complication that increases mortality and morbidity after surgery. Our objective is to investigate the possible role of the gut microbiome in anastomotic healing in patients with CRC. <h3>Methods</h3> Preoperative fecal samples were collected from CRC patients undergoing surgery. The gut microbiota of patients with AL and of others that presented optimal healing were analyzed and compared using the Anchor pipeline. Fecal microbiota transplantation (FMT) was performed in mice using preoperative fecal samples from CRC patients with and without AL. Mice were then subjected to colonic surgery using a colonic anastomosis model. After 6 days, anastomotic healing and the gut barrier were assessed. The gut microbiota composition was compared as well to detect potential differences between the groups of mice transplanted from donors with and without AL. <h3>Results</h3> Mice colonized by FMT with the microbiota of donors with AL displayed macroscopically poorer healing of the colonic anastomosis and a higher bacterial translocation to the spleen, suggestive of a weaker gut barrier after surgery. The anastomotic wounds of mice receiving the microbiota of AL donors displayed lower concentrations of collagen and fibronectin and higher inflammatory cytokines, indicating poor extracellular matrix formation after surgery. This was accompanied by a higher expression of collagenolytic enzymes, indicative of collagen degradation at the wound site. The beta diversity of the gut microbiota was significantly different between mice receiving the microbiota of donors with and without AL. Several bacterial species were differentially abundant between the two groups and were associated with the healing process. <h3>Conclusions</h3> The preoperative gut microbiota in CRC patients with poor postoperative healing induces poor healing in mice and a weaker gut barrier after surgery. These results suggest a causal role for the gut microbiota in colonic healing after surgery in patients with CRC.

ABSTRACTPurpose: We aimed to investigate the effects of caffeic acid phenethyl ester (CAPE) on wound healing in left colonic anastomoses in the presence of intraperitoneal sepsis induced by cecal ligation and puncture (CLP) in a rodent model. Methods: This experimental study was conducted on 48 male Wistar albino rats. The animals were randomly allocated into four groups and a left colonic anastomosis was performed on the day following sham operation or CLP in all rats: (i) sham-operated control group, laparatomy plus cecal mobilization (n = 12) (Group 1), (ii) sham + CAPE group, identical to Group 1 except for CAPE treatment (10 μmol/kg, intraperitoneally, 30 min before construction of the colonic anastomosis) (n = 12) (Group 2), (iii) CLP group, cecal ligation and puncture (n = 12) (Group 3), and (iv) CLP + CAPE-treated group, 10 μmol/kg, intraperitoneally, 30 min before the construction of colonic anastomosis (n = 12) (Group 4). On the postoperative day 7, the animals were subjected to relaparotomy for in-vivo measurement of the colonic anastomotic bursting pressure. A colonic segment including the anastomotic site was resected for histopathological evaluation and biochemical analyses of hydroxyproline (Hyp) contents, myeloperoxidase (MPO) acivity, malondialdehyde (MDA) levels, reduced glutathione (GSH) levels, and superoxide dismutase (SOD) activity. Body weight changes were examined. Results: CAPE treatment significantly increased colonic anastomotic bursting pressures (p < .05), colonic anastomotic tissue Hyp contents, and enzymatic and nonenzymatic antioxidant markers (p < .05), and significantly decreased oxidative stress parameters in colonic anastomotic tissues (p < .05). Histopathological scores were significantly better by CAPE administration (p < .05). Conclusion: This study clearly showed that CAPE treatment prevented the detrimental effects of intraperitoneal sepsis on colonic anastomotic wound healing. Further clinical studies are required to determine whether CAPE has a useful role in the enhancement of gastrointestinal anastomotic wound healing during particular surgeries in which sepsis-induced organ injury occurs.

Understanding the early processes underlying intestinal anastomotic healing is crucial to comprehend the pathophysiology of anastomotic leakage. The aim of this study was to assess normal intestinal anastomotic healing and disturbed healing in rats to investigate morphological, cellular and intrinsic molecular changes in the anastomotic tissue. Anastomoses were created in two groups of Wistar rats, using four sutures or 12 sutures to mimic anastomotic leakage and anastomotic healing respectively. At 6, 12, 24 hours and 2, 3, 5 and 7 days, anastomotic tissue was assessed macroscopically using the anastomotic complication score and histologically using the modified Ehrlich-Hunt score. Transcriptome analysis was performed to assess differences between anastomotic leakage and anastomotic healing at the first three time points to find affected genes and biological processes. Ninety-eight rats were operated on (49 animals in the anastomotic leakage and 49 in the anastomotic healing group) and seven rats analysed at each time point. None of the animals with 12 sutures developed anastomotic leakage macroscopically, whereas 35 of the 49 animals with four sutures developed anastomotic leakage. Histological analysis showed increasing influx of inflammatory cells up to 3 days in anastomotic healing and up to 7 days in anastomotic leakage, and this increase was significantly higher in anastomotic leakage at 5 (P = 0.041) and 7 days (P = 0.003). Transcriptome analyses revealed large differences between anastomotic leakage and anastomotic healing at 6 and 24 hours, mainly driven by an overall downregulation of genes in anastomotic leakage. Transcriptomic analyses revealed large differences between normal and disturbed healing at 6 hours after surgery, which might eventually serve as early-onset biomarkers for anastomotic leakage.

This experimental study evaluated the effectiveness and safety of using cyanoacrylate adhesive for sutureless colonic anastomosis and as a protective seal to prevent leakage. Sixty male Sprague-Dawley rats (300 +/- 10 g, 9 weeks old) were divided into three groups: in group I, the anastomosis was sutured in a single layer with 5-0 polypropylene; in group II, the anastomosis was fixed using N-butyl-2-cyanoacrylate (Histoacryl(R)); and in group III, the anastomosis was sutured and then sealed with N-butyl-2-cyanoacrylate. The rats were sacrificed on postoperative day 7. The anastomoses among the three groups were compared by measuring wound infection, anastomotic leakage, anastomotic stricture, adhesion formation, anastomotic bursting pressure, and histological appearance. No anastomotic leakage was observed in any group. Anastomotic stricture was significantly more extensive in groups II and III (p < 0.001). Bursting pressure was significantly lower in groups II and III (168 +/- 58, 45 +/- 21, and 60 +/- 38 mmHg for groups I to III, respectively, p < 0.001). The severity of inflammatory reactions was significantly greater and collagen deposition was significantly lower in groups II and III (p < 0.05). N-butyl-2-cyanoacrylate could be a useful method for sutureless colonic anastomosis based on the absence of anastomotic leakage, but it may impede healing of the colonic anastomosis. In addition, when used to seal sutured colonic anastomoses, cyanoacrylate may have a negative influence on anastomotic healing. The clinical use of N-butyl-2-cyanoacrylate in colonic anastomosis does not appear to be acceptable and safer anastomotic methods or alternative forms of cyanoacrylate should be developed.

Anastomotic leakage (AL), a major complication of colonic anastomoses, leads to prolonged hospital stays and increased mortality. Despite various interventions, AL incidence remains high at approximately 8%. Mesenchymal stem cells-derived small extracellular vesicles (MSCs-sEVs) have emerged as promising therapeutic agents because of their ability to exert immunoregulatory effects and promote tissue repair. Therefore, in this study, we investigated the role of MSC-sEVs in the healing of colonic anastomoses and elucidated the underlying mechanisms. In the preliminary experiments, male Sprague-Dawley rats were assigned to either a colonic obstruction or a sham surgery group, and the impact of acute colonic obstruction on colonic anastomosis healing was assessed, using an anastomotic complication score system. Based on observed impairment in ​healing progression, MSC-sEVs were administered topically in the subsequent experiments, and their therapeutic effects on anastomotic healing were analysed. Acute bowel obstruction impaired colonic anastomosis healing on postoperative day four; however, the topical administration of MSC-sEVs significantly improved healing. This was mainly demonstrated by reduced immune cell infiltration, downregulation of pro-inflammatory pathways, and decreased expression of inflammatory factors, effectively controlling excessive inflammatory responses in early AL healing phases. In rats, MSC-sEVs effectively improve the healing of acute bowel obstruction-impaired colonic anastomoses during early-phase disease.

Although many efforts have been made to improve management strategies and diagnostic methods in the past several decades, the prevention of anastomotic complications, such as anastomotic leaks and strictures, remain a major clinical challenge. Therefore, new molecular pathways need to be identified that regulate anastomotic healing, and to design new treatments for patients after anastomosis to reduce the occurrence of complications. Rabbits were treated with a MST1/2 inhibitor XMU-XP-1, a Chinese medicine formula Shenhuang plaster (SHP) or a control vehicle immediately after surgery. The anastomotic burst pressure, collagen deposition, and hydroxyproline concentration were evaluated at 3 and 7 days after the surgery, and qRT-PCR and western-blot analyses were used to characterize mRNA and protein expression levels. Both XMU-XP-1 and SHP significantly increased anastomotic burst pressure, collagen deposition, and the concentration of hydroxyproline in intestinal anastomotic tissue at postoperative day 7 (POD 7). Importantly, SHP could induce TGF-β1 expression, which activated its downstream target Smad-2 to activate the TGF-β1 signaling pathway. Moreover, SHP reduced the phosphorylation level of YAP and increased its active form, and treatment with verteporfin, a YAP-TEAD complex inhibitor, significantly suppressed the effects induced by SHP during anastomotic tissue healing. This study demonstrated that activation of the Hippo-YAP pathway enhances anastomotic healing, and that SHP enhances both the TGF-β1/Smad and YAP signaling pathways to promote rabbit anastomotic healing after surgery. These results suggest that SHP could be used to treat patients who underwent anastomosis to prevent the occurrence of anastomotic complications.

Continuous advancements and breakthroughs in flexible GI endoscopy have led to alternatives to colonic anastomosis. This study aimed to evaluate the feasibility and safety of end-to-end colonic anastomosis using a single flexible endoscope with the novel through-the-scope "bow-tie" device and conventional metal clips in a porcine model. Animal study. Animal laboratory at China Medical University. Eight healthy pigs were included. Eight animals underwent total colonic severance and anastomoses with through-the-scope "bow-tie" devices and metal clips. The primary outcomes were the success rate of the anastomosis and survival rate during 3-month follow-up. Furthermore, the secondary outcomes were anastomotic site healing, reintervention rate, and rate of anastomotic complications such as bleeding, leakage, stenosis, and obstruction. Six pigs were euthanized, and necropsies were performed 3 months postoperatively, whereas 2 pigs were fed for long-term observation. The anastomotic stoma was histologically analyzed using hematoxylin-eosin and Masson's trichrome staining. End-to-end colonic anastomoses were successfully performed using through-the-scope "bow-tie" devices and metal clips, and satisfactory healing was achieved in all pigs. The success rate of anastomosis was 100% (8/8). All animals survived postoperatively without anastomotic complications, including bleeding, leakage, or obstruction; however, 2 cases of stenosis occurred (25%) and 1 case (12.5%) required reintervention. Large-scale studies should be conducted to verify the feasibility and safety of the through-the-scope "bow-tie" device in other parts of the intestine. Flexible endoscopy with the through-the-scope "bow-tie" device is feasible and safe for intraluminal colonic anastomosis. This study may expand the indications for full-thickness endoscopic resection in the future. See Video Abstract . ANTECEDENTES:Con los avances en el tratamiento del cáncer de recto y el mejor pronóstico, hay un número creciente de sobrevivientes de cáncer de recto con necesidades únicas.OBJETIVOS:Presumimos que una proporción significativa de nuestros sobrevivientes de cáncer de recto carecen de acceso regular a un médico de atención primaria. El objetivo de nuestro estudio fue examinar la asociación entre el acceso a un médico de atención primaria y las visitas al departamento de emergencias relacionadas con la supervivencia.DISEÑO:Estudio de cohorte retrospectivo de supervivientes de cáncer de recto que finalizaron todo el tratamiento.PACIENTES:Pacientes con cáncer de recto que se sometieron a proctectomía y completaron el tratamiento entre 2005 y 2021.ESCENARIO:Centro único de atención terciaria en Quebec, Canadá.MEDIDA DE RESULTADO PRINCIPAL:Visitas al departamento de emergencias relacionadas con la supervivencia.RESULTADOS:En total, se incluyeron 432 sobrevivientes de cáncer de recto. La mediana de edad fue 72 (rango intercuartil 63-82) años, 190 (44,0%) eran mujeres y la mediana del índice de comorbilidad de Charlson fue 5 (rango intercuartil, 4-6). Había 153 (35,4%) personas no registradas con un médico de atención primaria. Sesenta personas visitaron el departamento de emergencias debido a preocupaciones relacionadas con la supervivencia. Utilizando el análisis de riesgos proporcionales de Cox, la falta de registro con un médico de atención primaria se asoció con una mayor probabilidad de tener visitas al departamento de emergencias relacionadas con la supervivencia.LIMITACIONES:Este estudio estuvo limitado por el diseño observacional.CONCLUSIÓN:La falta de acceso regular a un médico de atención primaria puede contribuir al aumento de las visitas al departamento de emergencia entre los sobrevivientes de cáncer de recto. Se necesitan esfuerzos para mejorar el acceso al médico de atención primaria y coordinar la atención interdisciplinaria para mejorar la atención a los sobrevivientes. (Traducción-Dr Osvaldo Gauto ).

Aim: To present our experience with experimental colonic anastomoses and compare it with the results of other experienced researchers.Materials and Method: The published experimental studies of our research group up to 1996, as well as results of other researchers in this field, are demonstrated and discussed. Different actions of administered substances on the anastomotic healing were compared and represented. Various chemotherapeutic agents were evaluated in experimental models without colorectal cancer as independent risk factors for the anastomotic healing. Moreover, numerous pharmaceutical agents such as steroids, immunomodulators, vasodilators and the use of fibrin glue are also assessed in detail.Results: Cytostatics, as well as steroids, impair the colonic anastomotic healing, but the combined administration of other agents can reverse this negative effect. Fibrin glue seems to protect the colonic anastomosis, while iloprost could be a potential candidate for further exploration in patient trials. Tacrolimus, despite its immunosuppressive action, seems to promote the anastomotic healing. This observation could be useful for patients with inflammatory bowel disease under tacrolimus therapy, who undergo a non-elective colectomy. Obstructive conditions predispose to anastomotic insufficiency, and therefore, substances to avoid this threatening complication are also assessed. Tacrolimus and iloprost showed a remarkable action against anastomotic leakage under artificially obstructive conditions.Conclusion: Further studies, especially in forms of clinical protocols, are necessary in order for these results to find their place in safe daily practice.

Introduction AL is one of the most severe complications after bowel resection. The incidence remains between 4-10% after colorectal surgery despite advancements in surgery and perioperative care. The intestinal microbiome’s regulation of host health and its impact on anastomotic healing are increasingly recognized, but the underlying mechanisms and strategies for clinical implementation remain poorly understood. In a prospective clinical study, we aim to identify the optimal timing of intestinal microbiome faecal sampling and to compare microbiomic differences in patients with anastomotic leak (AL) compared to no leak. Method Faecal samples were collected at three time points from patients with colorectal cancer undergoing intestinal resection and anastomosis, pre-operative (stool), operative (swab) and postoperative (stool). Shotgun sequencing was performed using MGI whole-genome sequencing technology. Result Of 42 patients, 6 suffered from AL. The operative swab sample had the highest level of ´high quality non host DNA´. The taxonomic overview at family level was similar between all time points. Alpha-diversity and overall microbiome community composition was more similar between pre-operative and operative samples compared to post-operative. No differences in microbiome composition or diversity were noticed between patients with or without AL. Bacterial propionate-synthesis was identified as a significant protective factor against AL. Discussion The intraoperative swab sample was the most feasible and informative, yielding the highest non-host DNA. Our findings highlight the value of functional microbiome profiling—especially short-chain fatty acid synthesis—as a potentially more relevant predictor of anastomotic healing than taxonomic composition alone. Future studies are planned to further elucidate these findings.