Short-term gut microbiota’s shift after laparoscopic Roux-en-Y vs one anastomosis gastric bypass: results of a multicenter randomized control trial

Flavio De Maio, Cristian Eugeniu Boru, Nunzio Velotti, Danila Capoccia, Giulia Santarelli, Ornella Verrastro, Delia Mercedes Bianco, Brunella Capaldo, Maurizio Sanguinetti, Mario Musella, Marco Raffaelli, Frida Leonetti, Giovani Delogu, Gianfranco Silecchia
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Abstract

Background

Roux-en-Y (RYGB) and one anastomosis gastric bypass (OAGB) represent two of the most used bariatric/metabolic surgery (BMS) procedures. Gut microbiota (GM) shift after bypass surgeries, currently understated, may be a possible key driver for the short- and long-term outcomes.

Methods

Prospective, multicenter study enrolling patients with severe obesity, randomized between OAGB or RYGB. Fecal and blood samples were collected, pre- (T0) and 24 months postoperatively (T1). GM was determined by V3-V4 16S rRNA regions sequencing and home-made bioinformatic pipeline based on Qiime2 plugin and R packages.

Objects

To compare OAGB vs RYGB microbiota profile at T1 and its impact on metabolic and nutritional status.

Results

54 patients completed the study, 27 for each procedure. An overall significant variation was detected in anthropometric and serum nutritional parameters at T1, with a significant, similar decrease in overall microbial alpha and beta diversity observed in both groups. An increase in relative abundances of Actinobacteria and Proteobacteria and a reduction of Bacteroidetes, no significant changes in Firmicutes and Verrucomicrobia, with an increase of the Firmicutes/Bacteroidetes ratio were observed.

Conclusions

BMS promotes a dramatic change in GM composition. This is the first multicenter, RCT evaluating the impact of OAGB vs Roux-en-Y bypass on GM profile. The bypass technique per se did not impact differently on GM or other examined metabolic parameters. The emergence of slightly different GM profile postoperatively may be related to clinical conditions or may influence medium or long-term outcomes and as such GM profile may represent a biomarker for bariatric surgery’s outcomes.

Graphical abstract

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腹腔镜 Roux-en-Y 胃旁路术与单吻合胃旁路术后短期肠道微生物群的变化:多中心随机对照试验的结果
背景Roux-en-Y(RYGB)和单吻合胃旁路术(OAGB)是最常用的两种减肥/代谢手术(BMS)。旁路手术后肠道微生物群(GM)的变化可能是短期和长期疗效的关键驱动因素。收集术前(T0)和术后 24 个月(T1)的粪便和血液样本。通过 V3-V4 16S rRNA 区域测序和基于 Qiime2 插件和 R 软件包的自制生物信息学管道确定 GM。研究发现,两组患者在 T1 期的人体测量和血清营养参数总体上有明显差异,微生物α和β多样性总体上有类似的明显下降。放线菌和变形菌的相对丰度增加,类杆菌减少,而固缩菌和纤毛菌无明显变化,固缩菌/类杆菌比率增加。这是第一项评估 OAGB 与 Roux-en-Y 搭桥术对基因组概况影响的多中心 RCT 研究。分流技术本身对基因组和其他代谢参数没有不同的影响。术后出现略微不同的基因组学特征可能与临床状况有关,也可能影响中期或长期预后,因此基因组学特征可能是减肥手术预后的生物标志物。
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