Skip to main content
Top
Published in: World Journal of Surgery 8/2011

01-08-2011

Compression Anastomosis Revisited: Prospective Audit of Short- and Medium-term Outcomes in 62 Rectal Anastomoses

Authors: Bernhard Dauser, Thomas Winkler, Gerhard Loncsar, Friedrich Herbst

Published in: World Journal of Surgery | Issue 8/2011

Login to get access

Abstract

Background

The ColonRing™ represents a further advancement in compression anastomosis by using superelastic materials. In contrast to other compression devices, its field of application is identical to circular staplers. Yet, limited data are available and there are no reports on the use of this compression device for anastomoses in the lower rectum and in diverted cases.

Methods

Between November 2008 and March 2010 a nonrandomized prospective study of patients undergoing colorectal resection was done.

Results

Sixty-two patients (30 female) with a median age of 67 years (range = 23-87) underwent surgery for benign (35) and malignant (27) indications;the surgery was performed laparoscopically in 53 (85.5%) cases. There were no leaks or other major complications related to the compression anastomosis. One patient died from sepsis caused by a leak of a colonic J-pouch. Three of 12 (25%) patients after (ultra-)low anterior resection experienced pain caused by the presence of the ring. Of 53 undiverted patients, rings were passed spontaneously in 52 (98.1%). No spontaneous passage occurred in patients with a stoma. Their rings were removed transanally prior to stoma closure. After a median of 6 months, endoscopic follow-up was performed in 60 patients (96.8%). Two anastomotic stenoses were detected (3.3%).

Conclusion

Construction of rectal anastomosis using this novel compression device is feasible and safe and appears to cause only few anastomotic strictures in the medium term. Discomfort or pain from the presence of the ring at anastomosis following (ultra-)low anterior resection can be observed in a relevant number of patients.
Literature
2.
go back to reference Docherty JG, McGregor JR, Akyol AM et al (1995) Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg 221:176–184PubMedCrossRef Docherty JG, McGregor JR, Akyol AM et al (1995) Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg 221:176–184PubMedCrossRef
3.
go back to reference Graf W, Gimelius B, Bergström R et al (1991) Complications after double and single stapling in rectal surgery. Eur J Surg 157:543–547PubMed Graf W, Gimelius B, Bergström R et al (1991) Complications after double and single stapling in rectal surgery. Eur J Surg 157:543–547PubMed
4.
go back to reference Rullier E, Laurent C, Garrelon JL et al (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358PubMedCrossRef Rullier E, Laurent C, Garrelon JL et al (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358PubMedCrossRef
5.
go back to reference Carlsen E, Schlichting E, Guldvog I et al (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85:526–529PubMedCrossRef Carlsen E, Schlichting E, Guldvog I et al (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85:526–529PubMedCrossRef
6.
go back to reference Matthiessen P, Hallböök O, Andersson M et al (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469PubMedCrossRef Matthiessen P, Hallböök O, Andersson M et al (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469PubMedCrossRef
7.
go back to reference Jech B, Felberbauer FX, Herbst F (2007) Complications of elective surgery for rectal cancer. Eur Surg 39:8–14CrossRef Jech B, Felberbauer FX, Herbst F (2007) Complications of elective surgery for rectal cancer. Eur Surg 39:8–14CrossRef
8.
go back to reference den Dulk M, Noter SL, Hendriks ER et al (2009) Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol 35:420–426 den Dulk M, Noter SL, Hendriks ER et al (2009) Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol 35:420–426
9.
go back to reference Taflampas P, Christodoulakis M, Tsiftsis DD (2009) Anastomotic leakage after low anterior resection for rectal cancer: facts, obscurity, and fiction. Surg Today 39:183–188PubMedCrossRef Taflampas P, Christodoulakis M, Tsiftsis DD (2009) Anastomotic leakage after low anterior resection for rectal cancer: facts, obscurity, and fiction. Surg Today 39:183–188PubMedCrossRef
10.
11.
go back to reference Wullstein C, Gross E (2000) Compression anastomosis (AKA-2) in colorectal surgery: results in 442 consecutive patients. Br J Surg 87:1071–1075PubMedCrossRef Wullstein C, Gross E (2000) Compression anastomosis (AKA-2) in colorectal surgery: results in 442 consecutive patients. Br J Surg 87:1071–1075PubMedCrossRef
12.
go back to reference Kaidar-Person O, Rosenthal R, Wexner SD et al (2008) Compression anastomosis: history and clinical considerations. Am J Surg 195:818–826PubMedCrossRef Kaidar-Person O, Rosenthal R, Wexner SD et al (2008) Compression anastomosis: history and clinical considerations. Am J Surg 195:818–826PubMedCrossRef
13.
go back to reference Chen TC, Ding KC, Yang MJ et al (1994) New device for biofragmentable anastomotic ring in low anterior resection. Dis Colon Rectum 37:834–836PubMedCrossRef Chen TC, Ding KC, Yang MJ et al (1994) New device for biofragmentable anastomotic ring in low anterior resection. Dis Colon Rectum 37:834–836PubMedCrossRef
14.
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
15.
go back to reference Stewart D, Hunt S, Pierce R et al (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 et al (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
16.
go back to reference Fasth S, Hedlund H, Svaninger G et al (1982) Autosuture of low colorectal anastomosis. Acta Chir Scand 148:535–539PubMed Fasth S, Hedlund H, Svaninger G et al (1982) Autosuture of low colorectal anastomosis. Acta Chir Scand 148:535–539PubMed
17.
go back to reference Shimada S, Matsuda M, Uno K et al (1996) A new device for the treatment of coloproctostomic stricture after double stapling anastomoses. Ann Surg 224:603–608PubMedCrossRef Shimada S, Matsuda M, Uno K et al (1996) A new device for the treatment of coloproctostomic stricture after double stapling anastomoses. Ann Surg 224:603–608PubMedCrossRef
18.
go back to reference Schlegel RD, Dehni N, Parc R et al (2001) Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 44:1464–1468PubMedCrossRef Schlegel RD, Dehni N, Parc R et al (2001) Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 44:1464–1468PubMedCrossRef
19.
go back to reference Ambrosetti P, Francis K, De Peyer R et al (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 et al (2008) Colorectal anastomotic stenosis after elective laparoscopic sigmoidectomy for diverticular disease: a prospective evaluation of 68 patients. Dis Colon Rectum 51:1345–1349PubMedCrossRef
20.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef
21.
go back to reference Ravitch MM, Steichen FM (1972) Technics of staple suturing in the gastrointestinal tract. Ann Surg 175:815–837PubMedCrossRef Ravitch MM, Steichen FM (1972) Technics of staple suturing in the gastrointestinal tract. Ann Surg 175:815–837PubMedCrossRef
22.
go back to reference Knight CD, Griffen F (1980) An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 88:710–714PubMed Knight CD, Griffen F (1980) An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 88:710–714PubMed
23.
go back to reference Griffen FD, Knight CD Sr, Whitaker JM et al (1990) The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg 211:745–751PubMedCrossRef Griffen FD, Knight CD Sr, Whitaker JM et al (1990) The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg 211:745–751PubMedCrossRef
24.
go back to reference Lustosa SA, Matos D, Atallah AN et al (2002) Stapled versus handsewn methods for colorectal anastomosis surgery: a systematic review of randomized controlled trials. Sao Paulo Med J 120:132–136PubMedCrossRef Lustosa SA, Matos D, Atallah AN et al (2002) Stapled versus handsewn methods for colorectal anastomosis surgery: a systematic review of randomized controlled trials. Sao Paulo Med J 120:132–136PubMedCrossRef
25.
go back to reference Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351PubMedCrossRef Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351PubMedCrossRef
26.
go back to reference Hansen O, Schwenk W, Hucke HP et al (1996) Colorectal stapled anastomoses. Experiences and results. Dis Colon Rectum 39:30–36PubMedCrossRef Hansen O, Schwenk W, Hucke HP et al (1996) Colorectal stapled anastomoses. Experiences and results. Dis Colon Rectum 39:30–36PubMedCrossRef
27.
go back to reference Eckmann C, Kujath P, Schiedeck TH et al (2004) Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis 19:128–133PubMedCrossRef Eckmann C, Kujath P, Schiedeck TH et al (2004) Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis 19:128–133PubMedCrossRef
28.
go back to reference Khan AA, Wheeler JM, Cunningham C et al (2008) The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis 10:587–592PubMedCrossRef Khan AA, Wheeler JM, Cunningham C et al (2008) The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis 10:587–592PubMedCrossRef
29.
go back to reference Hirano Y, Omura K, Tatsuzawa Y et al (2006) Tissue oxygen saturation during colorectal surgery measured by near-infrared spectroscopy: pilot study to predict anastomotic complications. World J Surg 30:457–461. doi:10.1007/s00268-005-0271-y PubMedCrossRef Hirano Y, Omura K, Tatsuzawa Y et al (2006) Tissue oxygen saturation during colorectal surgery measured by near-infrared spectroscopy: pilot study to predict anastomotic complications. World J Surg 30:457–461. doi:10.​1007/​s00268-005-0271-y PubMedCrossRef
30.
go back to reference D’Hoore A, Hompes D, Folkesson J et al (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 et al (2008) Circular ‘superelastic’ compression anastomosis: from the animal lab to clinical practice. Minim Invasive Ther Allied Technol 17:172–175PubMedCrossRef
31.
go back to reference Dauser B, Herbst F (2009) NITI Endoluminal Compression Anastomosis Ring (NITI CAR 27®): a breakthrough in compression anastomoses? Eur Surg 41:116–119CrossRef Dauser B, Herbst F (2009) NITI Endoluminal Compression Anastomosis Ring (NITI CAR 27®): a breakthrough in compression anastomoses? Eur Surg 41:116–119CrossRef
32.
go back to reference Tulchinsky H, Kashtan H, Rabau M et al (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 et al (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
33.
go back to reference Buchberg BS, Masoomi H, Bergman H et al (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(2):304–310PubMedCrossRef Buchberg BS, Masoomi H, Bergman H et al (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(2):304–310PubMedCrossRef
34.
go back to reference Ho YH, Ashour MA (2010) Techniques for colorectal anastomosis. World J Gastroenterol 16:1620–1621CrossRef Ho YH, Ashour MA (2010) Techniques for colorectal anastomosis. World J Gastroenterol 16:1620–1621CrossRef
35.
go back to reference Riss S, Stift A, Meier M et al (2010) Endo-sponge assisted treatment of anastomotic leakage following colorectal surgery. Colorectal Dis 12:104–108 Riss S, Stift A, Meier M et al (2010) Endo-sponge assisted treatment of anastomotic leakage following colorectal surgery. Colorectal Dis 12:104–108
36.
go back to reference van Koperen PJ, van Berge Henegouwen MI, Rosman C et al (2009) The Dutch multicenter experience of the endo-sponge treatment for anastomotic leakage after colorectal surgery. Surg Endosc 23:1379–1383PubMedCrossRef van Koperen PJ, van Berge Henegouwen MI, Rosman C et al (2009) The Dutch multicenter experience of the endo-sponge treatment for anastomotic leakage after colorectal surgery. Surg Endosc 23:1379–1383PubMedCrossRef
37.
go back to reference Maggiori L, Bretagnol F, Lefèvre JH et al (2011) Conservative management is associated with decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Colorectal Dis 13. doi:10.1111/j.1463-1318.2010.02252.x Maggiori L, Bretagnol F, Lefèvre JH et al (2011) Conservative management is associated with decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Colorectal Dis 13. doi:10.​1111/​j.​1463-1318.​2010.​02252.​x
38.
39.
go back to reference Suchan KL, Muldner A, Manegold BC (2003) Endoscopic treatment of postoperative colorectal anastomotic strictures. Surg Endosc 17:1110–1113PubMedCrossRef Suchan KL, Muldner A, Manegold BC (2003) Endoscopic treatment of postoperative colorectal anastomotic strictures. Surg Endosc 17:1110–1113PubMedCrossRef
40.
go back to reference Virgilio C, Cosentino S, Favara C et al (1995) Endoscopic treatment of postoperative colonic strictures using an achalasia dilator: short-term and long-term results. Endoscopy 27:219–222PubMedCrossRef Virgilio C, Cosentino S, Favara C et al (1995) Endoscopic treatment of postoperative colonic strictures using an achalasia dilator: short-term and long-term results. Endoscopy 27:219–222PubMedCrossRef
41.
go back to reference Waxman BP, Ramsay AH (1986) The effect of stapler diameter and proximal colostomy on narrowing at experimental circular stapled large bowel anastomosis. Aust N Z J Surg 56:797–801PubMedCrossRef Waxman BP, Ramsay AH (1986) The effect of stapler diameter and proximal colostomy on narrowing at experimental circular stapled large bowel anastomosis. Aust N Z J Surg 56:797–801PubMedCrossRef
42.
go back to reference Martínez-Serrano MA, Parés D, Pera M et al (2009) Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis. Tech Coloproctol 13:49–53PubMedCrossRef Martínez-Serrano MA, Parés D, Pera M et al (2009) Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis. Tech Coloproctol 13:49–53PubMedCrossRef
Metadata
Title
Compression Anastomosis Revisited: Prospective Audit of Short- and Medium-term Outcomes in 62 Rectal Anastomoses
Authors
Bernhard Dauser
Thomas Winkler
Gerhard Loncsar
Friedrich Herbst
Publication date
01-08-2011
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 8/2011
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-011-1135-2

Other articles of this Issue 8/2011

World Journal of Surgery 8/2011 Go to the issue