Randomized trial of a biofragmentable bowel anastomosis ring in high-risk colonic resection

Påhlman, Lars; Ejerblad, S; Graf, Wilhelm; Kader, F.; Kressner, Ulf; Lindmark, Gunilla; Raab, Yngve

doi:10.1046/j.1365-2168.1997.02771.x

Cited by 13 publications

(18 citation statements)

References 7 publications

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“…Recently published data from a European multicenter trial on compression anastomoses confirm these results: after 1,666 BAR anastomoses in the gastrointestinal tract a clinical leakage rate of 2.04% was reported [10]. Even high-risk colonic resections and anastomoses in previously irradiated colon reveal a low leakage rate of 4% [19]. …”

Section: Discussionsupporting

confidence: 63%

Long-Term Results after 75 Anastomoses in the Upper Extraperitoneal Rectum with the Biofragmentable Anastomosis Ring

Debus

Sailer²,

Geiger³

et al. 1999

Dig Surg

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Background: Anastomoses in the rectum have a higher risk for complications compared with other gastrointestinal regions. Stapling devices and sophisticated developments in surgical suture materials did not lead to a substantial decrease of local complications. The bioabsorbable anastomosis ring (BAR) is a new alternative technique for creating gastrointestinal anastomoses. Accordingly, the aim of this prospective study was to evaluate the postoperative course and long-term results of patients after anterior rectum resection using BAR. Methods: From 1991 to 1996 75 BAR anastomoses were performed in the upper rectum at the Department of Surgery, University Hospital Würzburg. Thirty-eight patients suffered from malignant, 37 from benign disease. Mean age was 61.4 years with no relevant differences in the gender. Mean follow-up was 31 months (4–63 months). The clinical course was evaluated, a questionnaire completed and/or a 3-monthly reevaluation with endoscopy conducted. Mortality, anastomostic bleeding, leakage and development of anastomotic stenosis were evaluated. Results: Sixty-seven patients could be reexamined. There was no postoperative mortality and no anastomotic bleeding. Six patients (8%) developed an anastomotic leakage, of whom 3 (4%) required reoperation. None of the patients revealed a detectable stenosis in the anastomotic region during follow-up. Conclusion: The BAR procedure is a safe and suitable anastomotic technique after anterior rectum resection.

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Section: Discussionsupporting

confidence: 63%

Long-Term Results after 75 Anastomoses in the Upper Extraperitoneal Rectum with the Biofragmentable Anastomosis Ring

Debus

Sailer²,

Geiger³

et al. 1999

Dig Surg

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“…The development of compression anastomosis began with Denan in 1826 followed by the simpler metallic Murphy's button in 1892 [3,4,7,8]. The Russians made the AKA-2 device in 1984 and Hardy and colleagues developed the Valtrac ring in 1985 [3,4,7,8,9,10,11,12,13,14,15,16,17]. In 2006, a nickel-titanium shape memory ring device was described in the literature [5,18,19,20,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…Foreign body reactions characterized by pathological inflammation might cause disturbed anastomotic healing contributing to leakage and stricture formation [3,4]. Numerous studies using the Valtrac ring have documented that the concept of compression anastomosis is safe for intestinal anastomoses in the gastrointestinal tract [3,4,7,8,9,10,11,12,13,14,15,16,17]. In fact, randomized investigations have also shown that the Valtrac ring is safe for colorectal anastomoses in patients at risk [9].…”

Section: Discussionmentioning

confidence: 99%

“…The BAR functions similarly to the Murphy's button by holding the two divided intestines together after securing the intestinal ends to the BAR with a purse-string suture. Although the feasibility and safety of using the BAR have been documented in numerous prospective and follow-up studies [3,4,7,8,9,10,11,12,13,14,15,16,17], the BAR turned out to be cumbersome to use and gained limited support among surgeons. Recently, a new compression device made of nickel-titanium (nitinol) shape memory rings has been reported to be safe and effective in the creation of colorectal anastomoses [5,18,19,20,21,22].…”

Section: Introductionmentioning

confidence: 99%

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The Compression Anastomotic Ring-Locking Procedure: A Novel Technique for Creating a Sutureless Colonic Anastomosis

et al. 2014

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Background/Aim: Compression anastomoses might represent an improvement over traditional hand-sewn or stapled techniques. Herein, we describe a novel concept of sutureless colonic anastomosis named compression anastomotic ring-locking procedure (CARP). Materials and Methods: The surgical device consists of two anastomotic rings and their associated helping tools, facilitating the placement of the rings into the intestinal ends. Furthermore, four catheters are connected to the surgical device, allowing the evaluation of the anastomosis during and after surgery. A total of 31 pigs underwent a low colocolic anastomosis using the anastomotic rings. The compression pressure was measured perioperatively and up to 96 h after surgery. Anastomotic integrity and morphology were analyzed by use of radiology and histology, respectively. A long-term follow-up was conducted in a subgroup of pigs up to 108 days after surgery when the bursting pressure and stricture formation were examined. Results: All animals recovered uneventfully, and macroscopic examination revealed intact anastomoses without signs of pathological inflammation or adhesions. The perioperative compression pressure was inversely proportional to the gap size between the anastomotic rings. For example, an anastomotic gap of 1.5 mm created a colonic anastomosis with a perioperative compression pressure of 91 mbar, which remained constant for up to 48 h and resulted in a markedly increased compression pressure. Contrast infusion via the catheters effectively visualized the anastomoses, and no leakage was detected within the study. The surgical device was spontaneously evacuated from the intestines within 6 days after surgery. Histology showed collagen bridging of the anastomoses already 72 h after surgery. Long-term follow-up (54-108 days) revealed no stricture formation in the anastomoses, and the bursting pressure ranged from 120 to 235 mbar. The majority of bursts (10/12) occurred distant from the anastomoses. Conclusion: We conclude that the surgical device associated to CARP is safe and efficient for creating colonic anastomoses. Further studies in patients undergoing colorectal surgery are warranted.

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“…141 Today the biofragmentable anastomotic ring, made of absorbable polyglycolic acid, is used most often. Four included experimental studies [107][108][109][110] showed that compression colorectal anastomosis leads to acceptable healing and strength; 6 included RCTs [111][112][113][114][115][116] provide equivalent conclusions, finding no significant differences between hand-sewn and compression colorectal anastomosis. Also, noncomparative clinical cohort studies [142][143][144][145] including up to 1360 patients have reported incidences of AL between 0.7% and 5%.…”

Section: Hand-sewn Vs Compression Colorectal Anastomosismentioning

confidence: 99%

Systematic Review of the Technique of Colorectal Anastomosis

Slieker

Daams²,

Mulder³

et al. 2013

JAMA Surg

166

102

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Randomized trial of a biofragmentable bowel anastomosis ring in high-risk colonic resection

Cited by 13 publications

References 7 publications

Long-Term Results after 75 Anastomoses in the Upper Extraperitoneal Rectum with the Biofragmentable Anastomosis Ring

Long-Term Results after 75 Anastomoses in the Upper Extraperitoneal Rectum with the Biofragmentable Anastomosis Ring

The Compression Anastomotic Ring-Locking Procedure: A Novel Technique for Creating a Sutureless Colonic Anastomosis

Systematic Review of the Technique of Colorectal Anastomosis

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