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

• Published in: World journal of surgery Vol. 35; no. 8; pp. 1925 - 1932
• Main Authors: Dauser, Bernhard, Winkler, Thomas, Loncsar, Gerhard, Herbst, Friedrich
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-08-2011; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Anastomosis, Surgical - instrumentation; Anastomotic Healing; Anastomotic Leakage; Biological and medical sciences; Cardiac Surgery; Colonic Pouches; Compression Device; Device Removal; Diverticular Disease; Equipment Design; Female; General aspects; General Surgery; Humans; Intestinal Obstruction - etiology; Male; Medical Audit; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Pain, Postoperative - etiology; Postoperative Complications - etiology; Pressure; Prospective Studies; Rectal Diseases - surgery; Rectal Neoplasms - surgery; Rectal Stump; Rectum - surgery; Surgery; Thoracic Surgery; Vascular Surgery; Young Adult; Anastomotic Healing; Diverticular Disease; Compression Device; Anastomotic Leakage; Rectal Stump; Short term; Medicine; Prospective; Audit; Compression; Prognosis; Treatment; Surgery; Anastomosis; Rectum; Evolution; Medium term
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-011-1135-2

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.