A biofragmentable bowel anastomosis ring (BAR) for sutureless intestinal anastomosis is described with the laboratory results comparing the BAR to sutured and stapled anastomoses. There was equivalent healing with all three methods of anastomosis. However, "burst" pressure was highest at day zero and overall necrosis was least with the BAR. By virtue of these findings and being sutureless, it is hoped that the limits of safe bowel anastomosis can be extended.

Twenty-seven patients have had bowel anastomoses with a biofragmentable ring for sutureless bowel anastomosis. There were no complications associated with the anastomotic technique. One patient developed an ischemic stricture on the proximal side of the anastomosis due to compromised circulation. There was no leakage. Technical factors regarding the BAR anastomosis are described. A properly placed purse-string suture is of primary importance. Advantages appear to be a more rapid and easy anastomosis with better healing.

The complication rate in jejunoileal bypass for morbid obesity is unacceptably high. Gastric bypass is technically difficult. In our series, 115 patients have undergone gastric partitioning for morbid obesity. The operation consists of stapling across the stomach below the gastroesophageal junction, leaving a gastric food reservoir of 50--60 cc. A 1 cm opening is left in the central portion of the staple line, allowing slow emptying into the distal stomach. The result is a reduced eating capacity and frequency which produce loss in weight. Three-quarters of the patients are women, and the age range is 17--62 years. Preoperative weights averaged 147 kg. Mean operative time was 48 minutes, and postoperative stay was 6.2 days. All patients were extensively evaluated preoperatively with upper GI series, cholecystogram, a number of blood chemistry tests, and endocrinologic and psychiatric consultations. All patients underwent a preoperative Minnesota Multiphasic Personality Inventory test. Cholecystectomy for cholelithiasis was performed on 18% of the patients at the time of operation. Of the seven patients operated on more than one year ago, five have lost an average of 31.6% of their preoperative weight. Of the 12 operated on less than one year but more than six months ago, eight have lost an average of 21% of their initial weight. The early failure rate of 33% has been reduced to 15% at present. One death occurred from pulmonary embolus 10 days following discharge, giving a mortality rate of .08%. The complication rate is 10%, comprising two pulmonary emboli, two psychoses, one wound dehiscence, one wound hernia, and ten wound infections, six of which were minor. There have been no complications of ulcer disease, reflux esophagitis, liver disease, renal disease, or metabolic disorders. Gastric partitioning is a safe, fast effective alternative for the surgical treatment of morbid obesity.

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