Uncertainty with the safety of the biofragmentable anastomosis ring makes surgeons hesitate in its widespread use in intestinal surgery. This study was designed to evaluate the validity of the biofragmentable anastomosis ring as a routine anastomotic device in enterocolic surgery.
The study analyzed the nine-year experience of 632 biofragmentable anastomosis ring anastomoses performed in 617 patients: 525 (83 percent) as elective procedures and 107 (17 percent) as emergency. Three classic types of anastomosis, end-to-end (n=354), end-to-side (n=263), and side-to-side (n=15), were performed with a standard technique.
Anastomotic sites included ileocolic/ileorectal in 283 patients (45 percent), colorectal in 148 (23 percent), enteroenteric in 101 (16 percent), and colocolic in 100 patients (16 percent). Anastomotic leakage with clinical relevance was observed in five patients (0.8 percent): three elective cases, and two emergency (2 colorectal anastomoses and 1 ileorectal required diversions). Among 13 instances (2.1 percent) with postoperative intestinal obstruction, only 1 required relaparotomy for closed-loop obstruction. Seven patients (1.1 percent; 4 elective cases, and 3 emergency) died postoperatively; no deaths were directly related to the biofragmentable anastomosis ring technique.
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.
"Our results demonstrate that patients with a jejuno-jejunal BAR anastomosis recover from upper gastrointestinal resections with no delay when compared to those with a manually sutured, conventional anastomosis. The most significant complication associated with anastomosis is anastomotic leakage : although the occurrence of severe complications was lightly more frequent in the suture group (8.5%) when compared with sutureless group (7.8%), they were independent of the enteroanastomosis. In particular, the none overall jejuno-jejunal leak rate in the present study, as exhibited also by other Authors (2-4.2%) "
[Show abstract][Hide abstract] ABSTRACT: The biofragmentable anastomotic ring has been used to this day for various types of anastomosis in the gastrointestinal tract, but it has not yet achieved widespread acceptance among surgeons. The purpose of this retrospective study is to compare surgical outcomes of sutureless with suture method of Roux-and-Y jejunojejunostomy in patients with gastric cancer.
Two groups of patients were obtained based on anastomosis technique (sutureless group versus hand sewn group): perioperative outcomes were recorded for every patient.
The mean time spent to complete a sutureless anastomosis was 11±4 min, whereas the time spent to perform hand sewn anastomosis was 23±7 min. Estimated intraoperative blood loss was 178±32ml in the sutureless group and 182±23ml in the suture-method group with no significant differences. No complications were registered related to enteroanastomosis. Intraoperative mortality was none for both groups.
The Biofragmentable Anastomotic Ring offers a safe and time-saving method for the jejuno-jejunal anastomosis in gastric cancer surgery, and for this purpose the ring has been approved as a standard method in our clinic. Nevertheless currently there are few studies on upper gastrointestinal sutureless anastomoses and this could be the reason for the low uptake of this device.
[Show abstract][Hide abstract] ABSTRACT: It has become increasingly necessary to develop a reliable sutureless technique to replace the conventional hand-sewn one for carrying out bilioenteric anastomosis.
A new sutureless technique for cholangiojejunostomy is described, and a retrospective review was conducted of a prospectively collected database, which included 11 patients who underwent sutureless cholangiojejunostomy between April 2005 and July 2006.
All patients successfully underwent sutureless cholangiojejunostomy, including choledochojejunostomy and hepaticojejunostomy. Median operative time was 13 minutes. There were no mortalities and no postoperative morbidities directly related to cholangiojejunostomy. At a mean follow-up period of 8.2 months, no patients had evidence of anastomotic stricture, except for 1 patient who developed obstructive jaundice because the recurrent tumor was pressing against the hepaticojejunal anastomosis.
Sutureless cholangiojejunostomy is simple, reliable, and feasible. Further larger-series studies, with longer follow-up periods and involving further improvements of the technique, are necessary before this procedure can become routine.
American journal of surgery 03/2008; 195(2):273-6. DOI:10.1016/j.amjsurg.2007.02.021 · 2.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite the fact that the concept of compression anastomosis has been investigated for nearly 2 centuries, it has not yet achieved widespread acceptance. The aim of the current report is to review the literature regarding compression anastomoses.
A multi-database search was conducted using PubMed, Ovid, and the Cochrane Databases (all until June 2007), in addition to electronic links to related articles and references of selected articles. The following terms were used for the search in various combinations: anastomosis, anastomoses, sutureless, compression, nickel-titanium; Nitinol; CAC; CAR; AKA-2, Valtrac biofragmentable anastomotic ring, BAR. Language restrictions were not applied.
The various methods of compression anastomosis have been shown to be at least comparable to the standard techniques of suturing and stapling. The measurement of outcomes, including cost, safety, and efficacy of treatment, indicated that compression anastomosis can save time, is cost-effective, and offers an acceptable cost/benefit ratio compared to both stapled and sutured anastomoses. However, compression anastomosis did not gain worldwide popularity.
American journal of surgery 07/2008; 195(6):818-26. DOI:10.1016/j.amjsurg.2007.10.006 · 2.29 Impact Factor
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