An experimental in vitro study involving ten hand-sutured, ten biofragmentable anastomotic ring (BAR) and ten stapled anastomoses was conducted to compare current anastomotic techniques on the basis of early bursting pressure. The 30 fresh human colon segments used in the study were harvested from patients who had undergone elective oncologic resection. Following the construction of in vitro anastomoses, the pressure required to burst these specimens was measured. The results showed no significant differences among the three techniques. Since hand-sutured anastomoses proved to be as effective and reliable as the other methods and can offer the advantage of cost savings, they should remain standard procedure in colorectal surgery.

Age itself cannot be considered a contraindication.

Purpose Considering a high prevalence of congenital and especially acquired bleeding disorders, their heterogeneity and the multitude of possible treatments strategies, a review of the scientific data on this topic is needed to implement a treatment guide for healthcare professionals. Methods A selective literature review was performed via PubMed for articles describing oral surgery / dental implant procedures in patients with congenital and acquired bleeding disorders. Out of the existing literature, potential treatment algorithms were extrapolated. Results In order to assess the susceptibility to bleeding, risk stratification can be used for both congenital and acquired coagulation disorders. This risk stratification, together with an appropriate therapeutic pathway, allows for an adequate and individualized therapy for each patient. A central point is the close interdisciplinary cooperation with specialists. In addition to the discontinuation or replacement of existing treatment modalities, local hemostyptic measures are of primary importance. If local measures are not sufficient, systemically administered substances such as desmopressin and blood products have to be used. Conclusions Despite the limited evidence, a treatment guide could be developed by means of this narrative review to improve safety for patients and practitioners. Prospective randomized controlled trials are needed to allow the implementation of official evidence-based guidelines.

Clinical outcome after X-Stop implantation might be considerably less favorable than when it was being published previously. Patient selection might be a reason for early revision surgery. More criteria for better X-Stop indications might be needed.