Compression anastomotic ring-locking procedure (CARP) is a safe and effective method for intestinal anastomoses following left-sided colonic resection

Vilhjalmsson, Dadi; Appelros, Stefan; Tóth, Ervin; Syk, Ingvar; Grönberg, Anders; Mynster, Tommie; Thorlacius, Henrik

doi:10.1007/s00384-015-2257-z

Cited by 7 publications

(12 citation statements)

References 27 publications

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“… 4 , 30 Recent compression anastomosis systems can be distinguished by their implant halves’ interlocking mechanism and the principle of permanent pressure application into form fit, shape memory, and magnet-based implants. While the compression rings in form fit-based systems (eg, AKA-2 (Seidel, Medipool, Friedrichsthal, Germany), 4 , 29 , 30 , 32 Valtrac, “Biofragmentable Anastomotic Ring” (BAR) (Sherwood-Davis & Geck, St. Louis, MO, USA) 4 , 6 , 12 , 30 , 33 , 34 and RapAn 4 , 35 ) consist of dimensionally stable materials (Metal, Polyetherketone or Polyglycolic acid), shape memory-based implants use the temperature-dependent shape changing effect of Nickel Titanium Alloy (NITINOL) for pressure application (eg, “Compression Anastomosis Clip” (CAC) (NiTi Alloys Technologies, Ltd., Netanya, Israel), “Compression Anastomosis Ring” (NiTi CAR or ColonRing) (novoGI Inc. formerly NiTi Surgical Solutions Ltd., Netanya, Israel)). 30 , 36–40 Both principles require mechanical closure mechanisms for the connection of the ring elements.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, it has been shown that compression anastomoses can potentially be compared with conventional and staple suturing techniques in terms of safety and surgical outcome, or in some cases even produce better results. 32 , 35 , 36 , 38 , 77 , 86 , 95 , 96 Especially, the expulsion of the compression implants enabling a foreign-body-free healing process, leading to less scarring, deserves notice. In their meta-analysis, however, Slesser et al concluded that there were no advantages with regard to postoperative complications in favor of compression anastomoses 15 and our meta-analysis also did not provide any evidence of superiority.…”

Section: Discussionmentioning

confidence: 99%

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Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

Steger¹,

Jell²,

Ficht³

et al. 2022

TCRM

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Purpose Anastomosis creation after resective gastrointestinal surgery is a crucial task. The present review examines the techniques and implants currently available for anastomosis creation and analyses to which extent they already address our clinical needs, with a special focus on their potential to enable further trauma minimization in visceral surgery. Methods A multi-database research was conducted in MEDLINE, Scopus, and Cochrane Library. Comparative controlled and uncontrolled clinical trials dealing with anastomosis creation techniques in the intestinal tract in both German and English were included and statistically significant differences in postoperative complication incidences were assessed using the RevMan5.4 Review Manager (Cochrane Collaboration, Oxford, UK). Results All methods and implant types were analyzed and compared with respect to four dimensions, assessing the techniques’ current performances and further potentials for surgical trauma reduction. Postoperative outcome measures, such as leakage, stenosis, reoperation and mortality rates, as well as the tendency to cause bleeding, wound infections, abscesses, anastomotic hemorrhages, pulmonary embolisms, and fistulas were assessed, revealing the only statistically significant superiority of hand-suture over stapling anastomoses with respect to the occurrence of obstructions. Conclusion Based on the overall complication rates, it is concluded that none of the anastomosis systems addresses the demands of operative trauma minimization sufficiently yet. Major problems are furthermore either low standardization potentials due to dependence on the surgeons’ levels of experience, high force application requirements for the actual anastomosis creation, or large and rigid device designs interfering with flexibility demands and size restrictions of the body’s natural access routes. There is still a need for innovative technologies, especially with regard to enabling incisionless interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

Steger¹,

Jell²,

Ficht³

et al. 2022

TCRM

View full text Add to dashboard Cite

show abstract

“…In 2006 the NiTi CAR 27 ring was introduced, which should guarantee consistent compression by nitinol springs. Newer methods are the CARP (compression anastomotic ring-locking procedure) [ 92 ] and the so-called Magnamosis by magnetic rings [ 93 ]. At a first glance, compression anastomoses could have advantages due to constant pressure distribution, avoiding local nutrient and blood undersupply, lack of gap formation, and foreign body reactions to staples or sutures.…”

Section: Comparison Of Conventional Techniquesmentioning

confidence: 99%

Innovative approaches for induction of gastrointestinal anastomotic healing: an update on experimental and clinical aspects

Reischl

Wilhelm

Frieß

2020

Langenbecks Arch Surg

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Purpose In most cases, traditional techniques to perform an anastomosis following gastrointestinal resections lead to successful healing. However, despite focused research in the field, in certain high-risk situations leakage rates remain almost unchanged. Here, additional techniques may help the surgeon to protect the anastomosis and prevent leakage. We give an overview of some of the latest developments on experimental and clinical techniques for induction of anastomotic healing. Methods We performed a review of the current literature on approaches to improve anastomotic healing. Results Many promising approaches with a high clinical potential are in the developmental pipeline. Highly experimental approaches like inhibition of matrix metalloproteinases, stem cell therapy, hyperbaric oxygen therapy, induction of the hypoxic adaptive response, and the administration of growth factors are still in the preclinical phase. Other more clinical developments aim to strengthen the anastomotic suture line mechanically while shielding it from the influence of the microbiome. Among them are gluing, seaming the staple line, attachment of laminar biomaterials, and temporary intraluminal tubes. In addition, individualized bowel preparation, selectively reducing certain detrimental microbial populations could become the next stage of bowel preparation. Compression anastomoses are evolving as an equivalent technique additional to established hand-sewn and stapled anastomoses. Fluorescence angiography and flexible endoscopy could complement intraoperative quality control additionally to the air leak tests. Virtual ileostomy is a concept to prepare the bowel for the easy formation of a stoma in case of leakage. Conclusion A variety of promising diagnostic and prophylactic measures that may support the surgeon in identifying high-risk anastomoses and support them according to their potential deficits is currently in development.

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“…Recently, a novel compression anastomotic device called CARP (compression anastomotic ring-locking procedure) has been introduced [ 28 ]. CARP allows not only a stapel-free anastomosis, but has also four built-in catheters enabling measurement of the intraoperative anastomotic contact pressure (ACP) and postoperative monitoring of potential leakage [ 28 , 29 ]. This makes CARP a unique device with capacity to quantify anastomotic integrity.…”

Section: Introductionmentioning

confidence: 99%

“…This makes CARP a unique device with capacity to quantify anastomotic integrity. A previous study showed that CARP was effective and safe in left-sided colo-colic anastomoses in patients undergoing resection of the sigmoid colon [ 29 ]. However, the CARP device is limited to open surgery and has now been modified in order to be used in minimally invasive procedures and for transanal rectal anastomoses.…”

Section: Introductionmentioning

confidence: 99%

Transanal formation of anastomosis using C-REX device is feasible and effective in high anterior resection

Vilhjalmsson

Lepsenyi

Syk

et al. 2023

Int J Colorectal Dis

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Purpose C-REX is a novel instrument for creating stapleless colorectal anastomosis by compression. The aim of this study was to evaluate the feasibility and effectiveness of C-REX in open and laparoscopic high anterior resections. Methods A prospective clinical safety study on 21 patients reconstructed with C-REX colorectal anastomosis following high anterior resection of the sigmoid colon using two different devices for intraabdominal (n = 6) or transanal (n = 15) placement of the anastomotic rings. Any signs of complications were prospectively monitored by a predefined protocol. Anastomotic contact pressure (ACP) was measured via a catheter-based system, and time for evacuation of the anastomotic rings by the natural route was noted. Blood samples were collected daily, and flexible endoscopy was performed postoperatively to examine macroscopic appearance of the anastomoses. Results One of six patients operated with the intraabdominal anastomosis technique with an ACP of 50 mBar had to be reoperated because of anastomotic leakage. None of the 15 patients operated with the transanal technique (5 open and 10 laparoscopic procedures) had anastomotic complications, and their ACP ranged between 145 and 300 mBar. C-REX rings were uneventfully expelled by the natural route in all patients after a median of 10 days. Flexible endoscopy showed well-healed anastomoses without stenosis in 17 patients and a moderate subclinical stricture in one patient. Conclusion These results indicate that the novel transanal C-REX device is a feasible and effective method for colorectal anastomosis following high anterior resections, irrespective of open or laparoscopic approach. Moreover, C-REX allows measurement of intraoperative ACP and thereby a quantitative evaluation of the anastomotic integrity.

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Compression anastomotic ring-locking procedure (CARP) is a safe and effective method for intestinal anastomoses following left-sided colonic resection

Abstract: Our results indicate that the novel suture-less CARP is a safe and effective method for creating colonic anastomoses. Further studies are warranted in larger patient populations to compare CARP head-on-head with stapled and/or hand-sewn colonic anastomoses.

Cited by 7 publications

References 27 publications

Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

Innovative approaches for induction of gastrointestinal anastomotic healing: an update on experimental and clinical aspects

Transanal formation of anastomosis using C-REX device is feasible and effective in high anterior resection

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