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The effect of surgical fecal stream diversion of the healthy colon on the colonic microbiota

van der Sluis, Wouter B.a,b; Bouman, Mark-Brama,b,c; Mullender, Margriet G.a,b,c; Degen, Malieka C.d; Savelkoul, Paul H.M.d,g; Meijerink, Wilhelmus J.H.J.c,e,h; de Boer, Nanne K.H.f; van Bodegraven, Adriaan A.f,i; Budding, Andries E.d

European Journal of Gastroenterology & Hepatology: April 2019 - Volume 31 - Issue 4 - p 451–457
doi: 10.1097/MEG.0000000000001330
Original Articles: Gastroenterology

Objectives The intestinal microbiota plays an important role in intestinal health. After colonic diversion from the fecal stream, luminal nutrients for bacteria are expected to be depleted, inducing changes in microbial composition. In this study, we describe microbial changes in the healthy colon following surgical fecal stream diversion, studied in the surgically constructed sigmoid-derived neovagina.

Methods At various postoperative times after sigmoid vaginoplasty, rectal, neovaginal, and skin microbial swabs were obtained for microbial analysis by interspacer profiling, a PCR-based bacterial profiling technique. Differences in bacterial profiles, in terms of bacterial abundance and phylum diversity, were assessed. Microbial dissimilarities between anatomical locations were analyzed with principal coordinate analysis and partial least squares discriminant analysis.

Results Bacterial samples were obtained from 28 patients who underwent sigmoid vaginoplasty. By principal coordinate analysis, microbial profiles of samples from the sigmoid-derived neovagina were distinctively different from rectal samples. Partial least squares discriminant analysis showed that the most discriminative species derived from the phylum Bacteroidetes. The abundance and diversity of Bacteroidetes species were reduced following fecal stream diversion compared with rectal samples (median Shannon diversity index of 2.76 vs. 2.18, P<0.01). Similar abundance of Phyla Firmicutes, Actinobacteria, Fusobacteria, Verrucomicrobia, and Proteobacteria was observed.

Conclusion By analyzing the microbiome of sigmoid-derived neovaginas, we studied the effects of fecal diversion on the microbial composition of the healthy intestine. Most changes were observed in the phylum Bacteroidetes, indicating that these bacteria are likely part of the diet-dependent (butyrate-producing) colonic microbiome. Bacteria of other phyla are likely to be part of the diet-independent microbiome.

aDepartment of Plastic, Reconstructive and Hand Surgery

bEMGO + Institute for Health and Care Research

cCentre of Expertise on Gender Dysphoria

dDepartment of Medical Microbiology and Infection Control

eDepartment of Gastro-Intestinal Surgery and Advanced Laparoscopy

fDepartment of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam

gDepartment of Medical Microbiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht

hDepartment of Operation Rooms, Radboud University Medical Centre, Nijmegen

iDepartment of Gastroenterology, Geriatrics, Intensive Care and Internal Medicine, Zuyderland Medical Centre, Geleen, The Netherlands

Correspondence to Wouter B. van der Sluis, MD, PhD, Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands Tel: +31 204 443 261; fax: +31 204 440 151; e-mail:

Received September 7, 2018

Accepted October 30, 2018

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