Skip to main content
Top
Published in: International Journal of Colorectal Disease 3/2012

01-03-2012 | Original Article

Anastomosis by use of compression anastomosis ring (CAR™ 27) in laparoscopic surgery for left-sided colonic tumor

Authors: Eun-Jung Koo, Hong-Jo Choi, Jin-Hee Woo, Ki-Jae Park, Young-Hoon Roh, Ki-Han Kim, Hak-Yoon Lee

Published in: International Journal of Colorectal Disease | Issue 3/2012

Login to get access

Abstract

Purpose

The safety and efficacy of the compression anastomosis ring (CAR™ 27) had been demonstrated by animal studies. This study was designed to evaluate clinical validity of the CAR™ 27 anastomosis in laparoscopic surgery for patients with left-sided colonic neoplasm.

Methods

Intracorporeal anastomosis using the CAR™ 27 (CAR group) was performed in 66 patients (male 35; median age, 64.5 years), and short-term results were compared with consecutive 116 patients (male 70; median age, 64 years) where the anastomosis was constructed by double stapling technique using a circular stapler for the same indications (stapled group).

Results

There were no statistically significant differences between the two groups in terms of gender, age, and distribution of pathologic lesion. The laparoscopic procedures, pathologic diagnosis/stage, and length of operation time and postoperative hospital stay were comparable between the two groups. Conversion rate in the CAR and stapled group was 3% and 6%, respectively. There was no surgical mortality in either group. No intraoperative complications associated with the CAR™ 27 anastomosis were encountered. One patient in the CAR group was complicated by anastomotic leakage and none in the stapled group (p = 0.36). There was intestinal obstruction in two patients, in whom one required re-operation for entrapped small bowel adhesions within pelvis. No patient in either group showed symptomatic anastomotic stricture.

Conclusions

The anastomosis using the CAR™ 27 is an innovative technique. The CAR™ 27 anastomosis in patients undergoing laparoscopic colectomy for left-sided colonic tumor proved to be a safe and efficacious alternative to the standard double stapling technique.
Literature
1.
go back to reference Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46:503–509PubMedCrossRef Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46:503–509PubMedCrossRef
2.
go back to reference Goriainov V, Miles AJ (2010) Anastomotic leak rate and outcome for laparoscopic intra-corporeal stapled anastomosis. J Minim Access Surg 6:6–10PubMedCrossRef Goriainov V, Miles AJ (2010) Anastomotic leak rate and outcome for laparoscopic intra-corporeal stapled anastomosis. J Minim Access Surg 6:6–10PubMedCrossRef
3.
go back to reference Kim JS, Cho SY, Min BS, Kim NK (2009) Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg 209:694–701PubMedCrossRef Kim JS, Cho SY, Min BS, Kim NK (2009) Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg 209:694–701PubMedCrossRef
4.
go back to reference Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, Bokey EL (2003) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 90:1261–1266PubMedCrossRef Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, Bokey EL (2003) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 90:1261–1266PubMedCrossRef
5.
go back to reference Petersen S, Freitag M, Hellmich G, Ludwig K (1998) Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis 13:160–163PubMedCrossRef Petersen S, Freitag M, Hellmich G, Ludwig K (1998) Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis 13:160–163PubMedCrossRef
6.
go back to reference MacRae HM, McLeod RS (1998) Handsewn vs. stapled anastomoses in colon and rectal surgery: a meta-analysis. Dis Colon Rectum 41:180–189PubMedCrossRef MacRae HM, McLeod RS (1998) Handsewn vs. stapled anastomoses in colon and rectal surgery: a meta-analysis. Dis Colon Rectum 41:180–189PubMedCrossRef
7.
go back to reference Beart AW, Kelly KA (1981) Randomized prospective evaluation of the EEA stapler for colorectal anastomosis. Am J Surg 141:143–147PubMedCrossRef Beart AW, Kelly KA (1981) Randomized prospective evaluation of the EEA stapler for colorectal anastomosis. Am J Surg 141:143–147PubMedCrossRef
8.
go back to reference Bannura GC, Cumsille MA, Barrera AE, Contreras JP, Melo CL, Soto DC (2004) Predictive factors of stenosis after stapled colorectal anastomosis: prospective analysis of 179 consecutive patients. World J Surg 28:921–925PubMedCrossRef Bannura GC, Cumsille MA, Barrera AE, Contreras JP, Melo CL, Soto DC (2004) Predictive factors of stenosis after stapled colorectal anastomosis: prospective analysis of 179 consecutive patients. World J Surg 28:921–925PubMedCrossRef
9.
go back to reference Ambrosetti P, Francis K, De Peyer R, Frossard JL (2008) Colorectal anastomotic stenosis after elective laparoscopic sigmoidectomy for diverticular disease: a prospective evaluation of 68 patients. Dis Colon Rectum 51:1345–1349PubMedCrossRef Ambrosetti P, Francis K, De Peyer R, Frossard JL (2008) Colorectal anastomotic stenosis after elective laparoscopic sigmoidectomy for diverticular disease: a prospective evaluation of 68 patients. Dis Colon Rectum 51:1345–1349PubMedCrossRef
10.
go back to reference Kopelman D, Lelcuk S, Sayfan J, Matter I, Willenz EP, Zaidenstein L, Hatoum OA, Kimmel B, Szold A (2007) End-to-end compression anastomosis of the rectum: a pig model. World J Surg 31:532–537PubMedCrossRef Kopelman D, Lelcuk S, Sayfan J, Matter I, Willenz EP, Zaidenstein L, Hatoum OA, Kimmel B, Szold A (2007) End-to-end compression anastomosis of the rectum: a pig model. World J Surg 31:532–537PubMedCrossRef
11.
go back to reference Murphy JB (1892) Cholecysto-intestinal, gastro-intestinal, entero-intestinal anastomosis, and approximation without sutures. Med Rec N Y 42:665–676 Murphy JB (1892) Cholecysto-intestinal, gastro-intestinal, entero-intestinal anastomosis, and approximation without sutures. Med Rec N Y 42:665–676
12.
go back to reference Hardy TG Jr, Pace WG, Maney JW, Katz AR, Kaganov AL (1985) A biofragmentable ring for sutureless bowel anastomosis. An experimental study. Dis Colon Rectum 28:484–490PubMedCrossRef Hardy TG Jr, Pace WG, Maney JW, Katz AR, Kaganov AL (1985) A biofragmentable ring for sutureless bowel anastomosis. An experimental study. Dis Colon Rectum 28:484–490PubMedCrossRef
13.
go back to reference Corman ML, Prager ED, Hardy TG Jr, Bubrick MP (1989) Comparison of the Valtrac biofragmentable anastomosis ring with conventional suture and stapled anastomosis in colon surgery. Results of a prospective, randomized clinical trial. Dis Colon Rectum 32:183–187PubMedCrossRef Corman ML, Prager ED, Hardy TG Jr, Bubrick MP (1989) Comparison of the Valtrac biofragmentable anastomosis ring with conventional suture and stapled anastomosis in colon surgery. Results of a prospective, randomized clinical trial. Dis Colon Rectum 32:183–187PubMedCrossRef
14.
go back to reference Thiede A, Geiger D, Dietz UA, Debus ES, Engemann R, Lexer GC, Lünstedt B, Mokros W (1998) Overview on compression anastomoses: biofragmentable anastomosis ring multicenter prospective trial of 1666 anastomoses. World J Surg 22:78–86PubMedCrossRef Thiede A, Geiger D, Dietz UA, Debus ES, Engemann R, Lexer GC, Lünstedt B, Mokros W (1998) Overview on compression anastomoses: biofragmentable anastomosis ring multicenter prospective trial of 1666 anastomoses. World J Surg 22:78–86PubMedCrossRef
15.
go back to reference Cahill CJ, Betzler M, Gruwez JA, Jeekel J, Patel JC, Zederfeldt B (1989) Sutureless large bowel anastomosis: European experience with the biofragmentable anastomosis ring. Br J Surg 76:344–347PubMedCrossRef Cahill CJ, Betzler M, Gruwez JA, Jeekel J, Patel JC, Zederfeldt B (1989) Sutureless large bowel anastomosis: European experience with the biofragmentable anastomosis ring. Br J Surg 76:344–347PubMedCrossRef
16.
go back to reference Bubrick MP, Corman ML, Cahill CJ, Hardy TG Jr, Nance FC, Shatney CH (1991) Prospective, randomized trial of the biofragmentable anastomosis ring. The BAR Investigational Group. Am J Surg 161:136–142PubMedCrossRef Bubrick MP, Corman ML, Cahill CJ, Hardy TG Jr, Nance FC, Shatney CH (1991) Prospective, randomized trial of the biofragmentable anastomosis ring. The BAR Investigational Group. Am J Surg 161:136–142PubMedCrossRef
17.
go back to reference Choi HJ, Kim HH, Jung GJ, Kim SS (1998) Intestinal anastomosis by use of the biofragmentable anastomotic ring: is it safe and efficacious in emergency operations as well? Dis Colon Rectum 41:1281–1286PubMedCrossRef Choi HJ, Kim HH, Jung GJ, Kim SS (1998) Intestinal anastomosis by use of the biofragmentable anastomotic ring: is it safe and efficacious in emergency operations as well? Dis Colon Rectum 41:1281–1286PubMedCrossRef
18.
go back to reference Szold A (2008) New concepts for a compression anastomosis: superelastic clips and rings. Minim Invasive Ther Allied Technol 17:168–171PubMedCrossRef Szold A (2008) New concepts for a compression anastomosis: superelastic clips and rings. Minim Invasive Ther Allied Technol 17:168–171PubMedCrossRef
19.
go back to reference Dauser B, Herbst F (2009) NITI endoluminal compression anastomosis ring (NITI CAR 27®): a breakthrough in compression anastomoses? Eur Surg 41:1–4CrossRef Dauser B, Herbst F (2009) NITI endoluminal compression anastomosis ring (NITI CAR 27®): a breakthrough in compression anastomoses? Eur Surg 41:1–4CrossRef
20.
go back to reference Stewart D, Hunt S, Pierce R, Mao D, Frisella M, Cook K, Starcher B, Fleshman J (2007) Validation of the NITI Endoluminal Compression Anastomosis Ring (EndoCAR) device and comparison to the traditional circular stapled colorectal anastomosis in a porcine model. Surg Innov 14:252–260PubMed Stewart D, Hunt S, Pierce R, Mao D, Frisella M, Cook K, Starcher B, Fleshman J (2007) Validation of the NITI Endoluminal Compression Anastomosis Ring (EndoCAR) device and comparison to the traditional circular stapled colorectal anastomosis in a porcine model. Surg Innov 14:252–260PubMed
21.
go back to reference Tulchinsky H, Kashtan H, Rabau M, Wasserberg N (2010) Evaluation of the NiTi Shape Memory BioDynamix ColonRing™ in colorectal anastomosis: first in human multi-center study. Int J Colorectal Dis 25:1453–1458PubMedCrossRef Tulchinsky H, Kashtan H, Rabau M, Wasserberg N (2010) Evaluation of the NiTi Shape Memory BioDynamix ColonRing™ in colorectal anastomosis: first in human multi-center study. Int J Colorectal Dis 25:1453–1458PubMedCrossRef
22.
go back to reference Senn N (1893) Enterorrhaphy; its history, technique and present status. JAMA 21:215–235 Senn N (1893) Enterorrhaphy; its history, technique and present status. JAMA 21:215–235
23.
go back to reference D'Hoore A, Hompes D, Folkesson J, Penninckx F, Pahlman L (2008) Circular 'superelastic' compression anastomosis: from the animal lab to clinical practice. Minim Invasive Ther Allied Technol 17:172–175PubMedCrossRef D'Hoore A, Hompes D, Folkesson J, Penninckx F, Pahlman L (2008) Circular 'superelastic' compression anastomosis: from the animal lab to clinical practice. Minim Invasive Ther Allied Technol 17:172–175PubMedCrossRef
24.
go back to reference Buchberg BS, Masoomi H, Bergman H, Mills SD, Stamos MJ (2011) The use of a compression device as an alternative to hand-sewn and stapled colorectal anastomoses: is three a crowd? J Gastrointest Surg 15:304–310PubMedCrossRef Buchberg BS, Masoomi H, Bergman H, Mills SD, Stamos MJ (2011) The use of a compression device as an alternative to hand-sewn and stapled colorectal anastomoses: is three a crowd? J Gastrointest Surg 15:304–310PubMedCrossRef
Metadata
Title
Anastomosis by use of compression anastomosis ring (CAR™ 27) in laparoscopic surgery for left-sided colonic tumor
Authors
Eun-Jung Koo
Hong-Jo Choi
Jin-Hee Woo
Ki-Jae Park
Young-Hoon Roh
Ki-Han Kim
Hak-Yoon Lee
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 3/2012
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-011-1310-9

Other articles of this Issue 3/2012

International Journal of Colorectal Disease 3/2012 Go to the issue