Salameh R, Samuel P, Virmani B, Ghobar F, Nohra L, Khaddaj M, Kumar R. Effects of perioperative nutritional status on the gastrointestinal anastomosis: A narrative review. World J Gastrointest Surg 2026; 18(4): 118338 [DOI: 10.4240/wjgs.v18.i4.118338]
Corresponding Author of This Article
Ray Salameh, MD, Department of General Surgery, Lebanese American University, Zahar Street, Achrafieh 1100, Lebanon. ray.salameh@lau.edu
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Surgery
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Apr 27, 2026 (publication date) through Apr 24, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Salameh R, Samuel P, Virmani B, Ghobar F, Nohra L, Khaddaj M, Kumar R. Effects of perioperative nutritional status on the gastrointestinal anastomosis: A narrative review. World J Gastrointest Surg 2026; 18(4): 118338 [DOI: 10.4240/wjgs.v18.i4.118338]
World J Gastrointest Surg. Apr 27, 2026; 18(4): 118338 Published online Apr 27, 2026. doi: 10.4240/wjgs.v18.i4.118338
Effects of perioperative nutritional status on the gastrointestinal anastomosis: A narrative review
Ray Salameh, Peter Samuel, Bhavya Virmani, Farah Ghobar, Lea Nohra, Marsel Khaddaj, Ranjith Kumar
Ray Salameh, Department of General Surgery, Lebanese American University, Achrafieh 1100, Lebanon
Peter Samuel, Ranjith Kumar, Faculty of Medicine, Tbilisi State Medical University, Tbilisi 0186, Georgia
Bhavya Virmani, Department of General Surgery, New Civil Hospital, Surat 395001, Gujarāt, India
Farah Ghobar, Department of Surgery, University of Balamand, Beirut 3852, Beirut, Lebanon
Lea Nohra, Faculty of Medicine, Lebanese University, Beirut 2050, Lebanon
Marsel Khaddaj, Faculty of Medicine, Beirut Arab University, Beirut 2050, Beirut, Lebanon
Co-corresponding authors: Ray Salameh and Bhavya Virmani.
Author contributions: Salameh R, Samuel P, and Virmani B conceptualized the proposal, article, and study design; Salameh R and Samuel P performed the data acquisition; Salameh R, Samuel P, Virmani B, Ghobar F, Nohra L, Khaddaj M, and Kumar R conducted the data analysis and drafted the article; Salameh R and Virmani B provided critical revision of the article for important intellectual content and approved the final version for publication, and as such their collaborative contributions are critical to the publication of this paper and to the ongoing nature of the project, underlying their designation as co-corresponding authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Ray Salameh, MD, Department of General Surgery, Lebanese American University, Zahar Street, Achrafieh 1100, Lebanon. ray.salameh@lau.edu
Received: January 28, 2026 Revised: March 5, 2026 Accepted: April 2, 2026 Published online: April 27, 2026 Processing time: 115 Days and 16.4 Hours
Abstract
This narrative review presents a synthesis of studies that examine the associations between perioperative nutritional status and its effects on gastrointestinal anastomosis, particularly the complications that can increase patient morbidity and mortality. A comprehensive literature search was conducted via five bibliographic databases: PubMed, Google Scholar, Scopus, ScienceDirect, and Cochrane, which included English language articles published recently. The results from the search yielded 151 articles, 46 of which were included for review on the basis of eligibility criteria. The results were identified within the following objectives: Anastomotic leakage, complications, recovery, length of hospital stay, and survival rates. Across more than 100000 gastrointestinal surgery cases reviewed, malnutrition was consistently associated with increased rates of postoperative complications (anastomotic leakage, surgical site infection, and increased length of hospital stay). Multimodal nutritional assessment tools (NRS-2002, PG-Subjective Global Assessment, and serum albumin) demonstrated strong predictive value for identifying postoperative complications. Although the data lacked sufficient evidence, early enteral nutrition was associated with a trend toward reduced infection and leakage rates. Preferential evidence revealed improved gut microbial balance and tissue tensile strength with probiotic supplementation, which may enhance anastomotic healing. Increasing perioperative nutritional status through a multidisciplinary approach is essential for reducing anastomotic leakage and improving surgical outcomes and recovery.
Core Tip: This study evaluated the outcomes of perioperative nutritional status on the gastrointestinal anastomosis along the different anatomical places where it can be created, exploring the different complications that arise in cases of malnutrition such as wound dehiscence, anastomotic leakage, surgical site infections, and ways to improve outcomes through a multidisciplinary approach mainly by implementing early enteral nutrition as well as the emerging concept of using probiotics.
