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

Abstract

Background/Aim: Compression anastomoses might represent an improvement over traditional hand-sewn or stapled techniques. Herein, we describe a novel concept of sutureless colonic anastomosis named compression anastomotic ring-locking procedure (CARP). Materials and Methods: The surgical device consists of two anastomotic rings and their associated helping tools, facilitating the placement of the rings into the intestinal ends. Furthermore, four catheters are connected to the surgical device, allowing the evaluation of the anastomosis during and after surgery. A total of 31 pigs underwent a low colocolic anastomosis using the anastomotic rings. The compression pressure was measured perioperatively and up to 96 h after surgery. Anastomotic integrity and morphology were analyzed by use of radiology and histology, respectively. A long-term follow-up was conducted in a subgroup of pigs up to 108 days after surgery when the bursting pressure and stricture formation were examined. Results: All animals recovered uneventfully, and macroscopic examination revealed intact anastomoses without signs of pathological inflammation or adhesions. The perioperative compression pressure was inversely proportional to the gap size between the anastomotic rings. For example, an anastomotic gap of 1.5 mm created a colonic anastomosis with a perioperative compression pressure of 91 mbar, which remained constant for up to 48 h and resulted in a markedly increased compression pressure. Contrast infusion via the catheters effectively visualized the anastomoses, and no leakage was detected within the study. The surgical device was spontaneously evacuated from the intestines within 6 days after surgery. Histology showed collagen bridging of the anastomoses already 72 h after surgery. Long-term follow-up (54-108 days) revealed no stricture formation in the anastomoses, and the bursting pressure ranged from 120 to 235 mbar. The majority of bursts (10/12) occurred distant from the anastomoses. Conclusion: We conclude that the surgical device associated to CARP is safe and efficient for creating colonic anastomoses. Further studies in patients undergoing colorectal surgery are warranted.

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

“…Up to now, there is no method for testing the quality of the anastomoses perioperatively and surgeons are left to evaluate colorectal anastomoses by morphological inspection and the use of an air leak test [26]. We have recently reported that the CARP catheter-based system allows quantification of the perioperative compression pressure in the anastomosis of pigs [25], which provides a direct feedback to the surgeon concerning the quality of the anastomosis immediately after its formation. In the present study, we demonstrate that the CARP system was easy to use and efficient in determining the anastomotic compression pressure in patients undergoing elective left-sided colonic resections.…”

“…Although these devices have been shown to be feasible and safe in numerous studies [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23], they do not allow measurement of the quality of the anastomosis perioperatively nor monitoring of the healing process in the anastomosis after surgery. However, the new CARP device (compression anastomotic ringlocking procedure) provides a catheter-based system with access to the healing area within the anastomosis, which allows perioperative measurement of the compression pressure between the intestinal ends within the anastomosis and postoperative monitoring of the anastomotic integrity as documented in a pig model [25]. In that pig study, it was found that CARP was a safe and effective method for colonic anastomoses warranting evaluation in patients undergoing colonic resection.…”

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

“…The C-REX device is a re ned CARP device [27,28] enabling use in minimally invasive surgery as well as transanal construction of a colorectal anastomosis. In brief, the C-REX is a snap-locking device, where the bowel ends are held together by a proximal-and a distal ring.…”

“…Recently, a novel compression anastomotic device called CARP has been introduced [27]. 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 [27,28]. This makes CARP a unique device with capacity to quantify anastomotic integrity.…”

A self-locking loop as an alternative to purse-string suture in colon anastomosis: a feasibility study

“…The methodology is in principal based on a device that locks the two intestinal ends together while the lumen remains open and allows passage of intestinal content. As the anastomosis heals, the short term implant will detach 7–10 days after surgery and follow feces out the natural way [ 11 ].…”