Sutureless Intestinal Anastomosis With the Biofragmentable Anastomosis Ring: Experience of 632 Anastomoses in a Single Institute

Abstract

Our data suggest that the anastomosis using the biofragmentable anastomosis ring is a uniform and highly reliable technique even in high-risk emergency surgery. Along with its clinical validities, clinical application of the biofragmentable anastomosis ring in different types of anastomoses in enterocolic surgery is expected to be expanded with a high level of technical safety.

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

“…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].…”

“…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].…”

“…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].…”

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

“…These devices are based on the principle of compression-induced healing in which the intestinal ends are joined together under compression, causing local necrosis which stimulates tissue healing in adjacent areas [6][7][8][9][10]. Numerous studies have demonstrated that anastomotic compression devices are comparable to the standard methods of hand suturing and stapling in terms of safety [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], but none of them has been established as a routine procedure in colorectal surgery.…”

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.…”