Abstract
Bariatric surgery is the most effective treatment for weight loss. Vertical sleeve gastrectomy (VSG) involves the resection of ~ 80% of the stomach and was conceived to purely restrict oral intake. However, evidence suggests more complex mechanisms, particularly postoperative changes in gut microbiota, in facilitating weight loss and resolving associated comorbidities. VSG in humans is a complex procedure and includes peri-operative antibiotics and caloric restriction in addition to the altered anatomy. The impact of each of these factors on the intestinal microbiota have not been evaluated. The aim of this study was to determine the relative contributions of each of these factors on intestinal microbiota composition following VSG prior to substantial weight loss. Thirty-two obese patients underwent one of three treatments: (1) VSG plus routine intravenous peri-operative antibiotics (n = 12), (2) VSG with intravenous vancomycin chosen for its low intestinal penetrance (n = 12), and (3) caloric restriction (n = 8). Fecal samples were evaluated for bacterial composition prior to and 7 days following each intervention. Only patients undergoing VSG with routine peri-operative antibiotics showed a significant shift in community composition. Our data support the single dose of routine peri-operative antibiotics as the most influential factor of intestinal microbial composition acutely following VSG.
Highlights
Bariatric surgery is the most effective treatment for weight loss
Changes in the composition of the gut microbiota following bariatric surgery have been causally linked to weight loss and metabolic improvement[14,24,25]
The aim of this study was to evaluate the relative contributions of the peri-operative antibiotics and caloric restriction to the postsurgical changes in the intestinal microbiota acutely following Vertical sleeve gastrectomy (VSG) prior to substantial weight loss
Summary
Bariatric surgery is the most effective treatment for weight loss. Vertical sleeve gastrectomy (VSG) involves the resection of ~ 80% of the stomach and was conceived to purely restrict oral intake. VSG was conceived as a purely restrictive surgery to limit oral intake, recent evidence suggests more complex underlying mechanisms, postoperative changes in the composition of the intestinal microbiota, which facilitate weight loss and counteract important comorbidities such as T2DM. While animal studies are performed in a controlled setting, bariatric surgery in humans is a very complex intervention that includes caloric restriction and peri-operative antibiotics in addition to the anatomic alteration. These factors represent significant confounders in investigating changes in the intestinal microbiota. Characterizing the impact of antibiotics and caloric restriction on intestinal microbial composition is important for the broader understanding of the physiologic consequences of these interventions but important in the bariatric setting in which the ultimate goal is maximizing weight loss and metabolic benefit
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