Physical prehabilitation improves colonic anastomosis healing in a malnourished rat model only if attached to effective nutritional prehabilitation - Experimental study.

Abstract

BACKGROUND: The importance of prehabilitation prior to colorectal surgery has recently gained attention. However, existing literature on its effectiveness is contradictory. Therefore, we investigated the impact of different prehabilitation protocols on intestinal anastomotic healing and the gut microbiome in a malnourished rat model. METHODS: Rats were divided into 6 groups: ad libitum fed, ad libitum fed with exercise prehabilitation, malnourished, malnourished with exercise prehabilitation, malnourished with nutritional prehabilitation, and malnourished with combined nutritional and exercise prehabilitation. After 4 weeks of prehabilitation, body weight, body composition (measured by magnetic resonance imaging), gut circulation (assessed by short-wave infrared imaging), and microbiome diversity (evaluated by 16S rRNA sequencing) were determined. Colon resection and anastomosis were then performed. Anastomotic healing was assessed using the rat grimace scale, bursting pressure, adhesion score, bowel motility tests, and histopathologic examination. Correlations between microbiome composition and anastomotic healing parameters were also analyzed. RESULTS: Malnutrition negatively affected all measured parameters related to body composition and postoperative outcomes. Physical prehabilitation alone did not improve these parameters in malnourished rats, whereas nutritional and bimodal prehabilitation successfully restored them. Specifically, these interventions led to improved body composition (P < .001), enhanced bowel perfusion (P < .05), and improved anastomotic healing (bursting pressure: P < .001; rat grimace scale: P < .0001; adhesion score: P < .0001) compared with untreated malnourished controls. Furthermore, nutritional and bimodal prehabilitation favorably modulated the fecal microbiome. CONCLUSION: Our study demonstrates that nutritional and bimodal prehabilitation plays a primary role in improving colonic anastomotic healing under malnourished conditions. Moreover, we show for the first time that different prehabilitation protocols significantly influence the fecal microbiome, which may be fundamental to postoperative recovery.