• Kristina Žukauskaitė, Angela Horvath, Žilvinas Gricius, Mindaugas Kvietkauskas, Bernardas Baušys, Audrius Dulskas, Justas Kuliavas, Rimantas Baušys, Simona Rūta Letautienė, Ieva Vaicekauskaitė, Rasa Sabaliauskaitė, Augustinas Baušys, Vanessa Stadlbauer, and Sonata Jarmalaitė.
• Institute of Biosciences, Life Sciences Centre, Vilnius University, Vilnius, Lithuania.
• Br J Surg. 2024 Aug 30; 111 (9).

BackgroundPostoperative complications after colorectal cancer surgery have been linked to the gut microbiome. However, the impact of mechanical bowel preparation using oral preparation agents or rectal enema on postoperative infections remains poorly understood. This study aimed to compare the impact of oral preparation and rectal enema on the gut microbiome and postoperative complications.MethodsThis open-label pilot RCT was conducted at the National Cancer Institute, Vilnius, Lithuania. Patients with left-side colorectal cancer scheduled for elective resection with primary anastomosis were randomized 1 : 1 to preoperative mechanical bowel preparation with either oral preparation or rectal enema. Stool samples were collected before surgery, and on postoperative day 6 and 30 for 16S rRNA gene sequencing analysis. The primary outcome was difference in β-diversity between groups on postoperative day 6.ResultsForty participants were randomized to oral preparation (20) or rectal enema (20). The two groups had similar changes in microbiome composition, and there was no difference in β-diversity on postoperative day 6. Postoperative infections occurred in 12 patients (32%), without differences between the study groups. Patients with infections had an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species.ConclusionMechanical bowel preparation with oral preparation or rectal enema resulted in similar dysbiosis. Patients who experienced postoperative infections exhibited distinct gut microbiome compositions on postoperative day 6, characterized by an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species.Registration NumberNCT04013841 (http://www.clinicaltrials.gov).© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

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