Histopathologic Advantages of Compression Ring Anastomosis Healing as Compared With Stapled Anastomosis in a Porcine Model

Berho, Mariana; Wexner, Steven D.; Botero-Anug, Ana-Maria; Pelled, Dori; Fleshman, James W.

doi:10.1097/dcr.0000000000000009

Cited by 21 publications

(17 citation statements)

References 27 publications

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“…Without a permanent suture remaining, the use of this device reduces the local long-term inflammatory process of anastomosis. Moreover, the scarring area of the anastomosis is minimal and appears smooth during the healing process 19 - 21 . Although the US Food and Drug Administration (FDA) approved NiTi CAR™ 27 for use in intestinal anastomoses in August 2006, clinical experiments using NiTi CAR 27 in colorectal anastomosis are scarce in China.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients

Lu¹,

Peng²,

Liu³

et al. 2016

Clinics

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OBJECTIVES:This study aimed to evaluate the safety and efficacy of a new nickel-titanium shape memory alloy compression anastomosis ring, NiTi CAR 27, in constructing an anastomosis for colorectal cancer resection compared with conventional staples.METHODS:In total, 234 consecutive patients diagnosed with colorectal cancer receiving sigmoidectomy and anterior resection for end-to-end anastomosis from May 2010 to June 2012 were retrospectively analyzed. The postoperative clinical parameters, postoperative complications and 3-year overall survival in 77 patients using a NiTi CAR 27 compression ring (CAR group) and 157 patients with conventional circular staplers (STA group) were compared.RESULTS:There were no statistically significant differences between the patients in the two groups in terms of general demographics and tumor features. A clinically apparent anastomotic leak occurred in 2 patients (2.6%) in the CAR group and in 5 patients (3.2%) in the STA group (p=0.804). These eight patients received a temporary diverting ileostomy. One patient (1.3%) in the CAR group was diagnosed with anastomotic stricture through an electronic colonoscopy after 3 months postoperatively. The incidence of postoperative intestinal obstruction was comparable between the two groups (p=0.192). With a median follow-up duration of 39.6 months, the 3-year overall survival rate was 83.1% in the CAR group and 89.0% in the STA group (p=0.152).CONCLUSIONS:NiTi CAR 27 is safe and effective for colorectal end-to-end anastomosis. Its use is equivalent to that of the conventional circular staplers. This study suggests that NiTi CAR 27 may be a beneficial alternative in colorectal anastomosis in Chinese colorectal cancer patients.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients

Lu¹,

Peng²,

Liu³

et al. 2016

Clinics

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“…Compression anastomosis consists of a stapler equipped with disposable rings used for colorectal anastomosis: The rings are applied on each side at the anastomotic level and are evacuated into the stools once tissue necrosis and healing have occurred. A study performed in pigs with colorectal anastomoses showed that compression anastomosis was associated with less inflammation and scarring when compared with the stapling technique[51]. A retrospective multicentric study including 1’180 patients described an AL rate of 3.22% using the ColonRing device[52].…”

Section: Operative Measures To Prevent Almentioning

confidence: 99%

Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges

Meyer¹,

Naiken²,

Christou³

et al. 2019

WJG

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Anastomotic leak (AL) constitutes a significant issue in colorectal surgery, and its incidence has remained stable over the last years. The use of intra-abdominal drain or the use of mechanical bowel preparation alone have been proven to be useless in preventing AL and should be abandoned. The role or oral antibiotics preparation regimens should be clarified and compared to other routes of administration, such as the intravenous route or enema. In parallel, preoperative antibiotherapy should aim at targeting collagenase-inducing pathogens, as identified by the microbiome analysis. AL can be further reduced by fluorescence angiography, which leads to significant intraoperative changes in surgical strategies. Implementation of fluorescence angiography should be encouraged. Progress made in AL comprehension and prevention might probably allow reducing the rate of diverting stoma and conduct to a revision of its indications.

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“…However, the design of the device aimed to fit with any sized circular stapler, but additional tests are needed. In addition to circular staplers and CREX, other anastomosis techniques exist [ 19 , 20 ]. Additional tests of the developed self-locking device throughout the available range of techniques of anastomosis and their different instrument sizes remain to be performed.…”

Section: Discussionmentioning

confidence: 99%

A self-locking loop as an alternative to purse-string suture in colon anastomosis: a feasibility study

Höglund

Maxon

Grönberg³

2017

BMC Res Notes

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BackgroundColorectal cancer is common in humans where treatment involves surgical removal of the cancerous part of the intestines. In the anastomosis procedure a purse-string suture may be time consuming to perform. The aim was to replace the purse-string suture, to develop and test a self-locking loop for temporary sealing of the lumen in colon anastomosis.MethodsA new device, a flexible band with a locking mechanism was constructed, the I-Tie®. Small protrusions, designed for increased friction between device and tissue, were added to one side of the flexible band in order to enhance the grip at closure of the loop around tissue. The device was initially tested in vitro on pig intestines. In an in vivo study, the short-term implant was tested in a new suture-free method, CREX, and with traditional circular staplers for colonic anastomosis. Ten female pigs of approximately 50 kg were used in the in vivo test. The self-locking device was used for closure of the lumen around anvils in CREX (n = 5), and around anvil in traditional circular stapler anastomosis (n = 5). Two self-locking devices were used in each animal.ResultsThe self-locking device could close the lumen of colon around the anvil and trocar. Subjectively, the device achieved a tight closure of the colon and did not interfere with the anastomosis techniques.ConclusionsThe technology was perceived as potentially timesaving and easy to use. We conclude the device may be an alternative to the traditional purse-string suture for temporary closure of the colon lumen in colon anastomosis.

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Histopathologic Advantages of Compression Ring Anastomosis Healing as Compared With Stapled Anastomosis in a Porcine Model

Abstract: Compression anastomotic healing was associated with less foreign body reactions, scarring, and inflammation as compared with stapled anastomoses in a large animal model.

Cited by 21 publications

References 27 publications

Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients

Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients

Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges

A self-locking loop as an alternative to purse-string suture in colon anastomosis: a feasibility study

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