Overview on Compression Anastomoses: Biofragmentable Anastomosis Ring Multicenter Prospective Trial of 1666 Anastomoses

Abstract

This study represents a European prospective clinical multicenter trial and was undertaken to evaluate the applicability of the biofragmentable anastomosis ring (BAR) as a routine anastomotic tool in teaching hospitals. The trial results analyzed consisted of 1666 BAR anastomoses performed in 1360 patients from March 1989 to May 1996 in the upper (1042 anastomoses) and lower (624 anastomoses) gastrointestinal (GI) tract. Only patients selected for elective procedures and having previously undergone orthograde bowel cleansing were entered into the trial. In the upper GI tract six anastomoses (0.58%) developed clinically relevant and radiologically detectable leaks with indications for reoperation. In the lower GI tract 42 (6.73%) anastomoses showed a radiologically detectable leak with clinical manifestations in 28 cases (4.48%). Reoperation was performed in 18 cases (2.80%). The overall leakage rate with clinical relevance was 2.04%. Three gastrojejunostomy episodes of bleeding were observed (0.18%) at the BAR anastomotic site. During the early postoperative course there was no ileus due to obstruction of a BAR anastomosis. Reintroduction of diet after the operation was not delayed. In two centers a follow-up evaluation reported no BAR-related late anastomotic stenoses. There were no intraoperative deaths, but 54 patients died postoperatively. Peritonitis following anastomotic leakage was responsible for postoperative deaths in four cases; three of them were related to BAR anastomoses. In conclusion, the BAR anastomotic procedure is an established, rapid, simple to learn, highly standardized, safe technique with the advantage of no persistent foreign material in the anastomotic region and therefore no induction of stenosis. At present, the application of anastomoses in various segments of the GI tract, from the stomach to the middle third of the rectum, can be recommended.

The measurement and monitoring of surgical adverse events

“…Thiede and co-workers 209 Clinically indicated by retarded bowel function, fever and localised abdominal fluid.…”

“…Thiede and co-workers 209 conducted a European clinical trial over six centres to evaluate the applicability of a biofragmentable anastomotic ring in upper and lower gastrointestinal surgery in 1360 patients. This was the largest prospective study from the included gastrointestinal literature.…”

Systematic Review of the Technique of Colorectal Anastomosis

“…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%. Although few gastrointestinal sur- Abbreviations: see Table 1; ETE, end-to-end; ETS, end-to-side; NIR, not included in the present review (in case a supplemental subgroup was also studied, outside the topic of this review); STE, side-to-end; STS, side-to-side.…”

Compression anastomosis clip for gastrointestinal anastomosis

“…Ischemia, inflammation, and fibrosis due to anastomosis leakage are the factors for anastomotic stenosis [15,16] . No sign of anastomotic stenosis at compression anastomotic site was observed either in upper gastrointestinal contrast radiography early postoperatively or in the endoscopy after a long-term follow-up period.…”

“…None of the patients complained of abdominal pain due to dietary. However, Thiede and colleagues conducted a multicenter prospective trial of biofragmentable anastomosis ring and found that a low fiber diet until the evacuation of ring fragments from the bowel could prevent obstruction with no discomfort [16] . The recovery course of 7 patients with a compression anastomosis who had complete intestinal obstruction before surgery, was uneventful and similar to those without complete intestinal obstruction before operation, which might be related to the characteristics of the CAC.…”