Anastomotic Device Research Articles

Prospective controlled pilot study of arteriovenous fistula placement using the novel Optiflow device

Arteriovenous fistula (AVF) maturation failure remains a significant problem with reported early failure rates around 50%. Suboptimal hemodynamics, variable surgical skills, and technique dependency are widely believed to contribute to AVF nonmaturation. The Optiflow (Bioconnect Systems, Ambler, Pa) is a novel anastomotic device placed in situ that has potential for improving hemodynamics and standardizing AVF placement. We report results from a prospective nonrandomized controlled pilot study designed to investigate the safety and performance of the Optiflow. Forty-one participants underwent AVF formation using either a 3-mm or 4-mm Optiflow and 39 matched control participants underwent AVF formation using the standard technique at two sites. Patients were observed for 90 days after AVF placement. The primary end point was unassisted maturation, which was defined as an outflow vein with a diameter ≥5 mm and blood flow ≥500 mL/min measured by Doppler ultrasound. The secondary performance end point was unassisted patency, and the primary safety end point was freedom from device-related serious adverse events. Unassisted maturation rates at 14, 42, and 90 days were 76%, 72%, and 68%, respectively, for the Optiflow group and 67%, 68%, and 76%, respectively, in the control group (P = .38, .69, and .47 at 14, 42, and 90 days). There was a trend to earlier maturation (assessed at 14 days) in the 4-mm Optiflow group compared with the control group (P = .059). There were no device-related serious adverse events. Maturation results for both the Optiflow and control groups were highly favorable compared with historical assisted maturation rates of approximately 50%. The Optiflow appears to be safe and effective in the placement of AVFs, with high maturation rates.

Abstract 15504: A New Coronary Anastomotic Connector in a Preclinical Safety Study

Introduction: A facilitated construction of a distal coronary anastomosis is the key towards less invasive coronary bypass surgery, ideally in an endoscopic hybrid approach. This study evaluates a new laser-assisted, zero ischemia coronary anastomotic connector in comparison to the hand-sutured anastomotic technique, in a long-term follow-up porcine off-pump bypass model. The initial results of this preclinical comparative safety study are presented. Hypothesis: We assessed the hypothesis that the coronary connector is not inferior to the hand-sutured technique, in terms of patency, healing, and hemodynamic function. Methods: In 22 pigs (3 months follow-up, n=10; 6 months follow-up, n=12), the so-called Trinity Clip connector facilitated a LITA-to-LAD anastomosis, and in 14 pigs (3 months follow-up, n=6; 6 months follow-up, n=8) the anastomosis was hand-sutured. All anastomoses (n=36) were evaluated intraoperatively by means of graft flow measurements and at follow-up by angiography and histology. Results: After construction, complete hemostasis was obtained in 95% (21/22) of the connector facilitated anastomoses and in 86% (12/14) of the hand-sutured. Both groups had a mean coronary outer diameter of 1.8 ± 0.1 mm. The mean peak hyperemic flow response (peak [following 30-second graft occlusion]/base flow) was 4.1 ± 1.0 in the connector group versus 4.2 ± 1.1 in the hand-sutured group. The patency in both groups was 100% (connector group: at 6 months [n=3/3] and 3 months [n=5/5]; hand-sutured group: at 6 months [n=1/1] and 3 months [n=4/4]). Conclusions: The initial data of this preclinical study demonstrates similar anastomosis success rate in both groups. The connector is easy-to-use and seems to be safe and reliable in the long-term porcine off-pump bypass model. Complete data on the long-term will be expected soon and the resulting histological and angiographic data will further elucidate the future relevance of this new coronary anastomotic device. In conclusion, albeit the preliminary study status, the connector has potential to facilitate minimally invasive or endoscopic CABG.

Histological characteristics of collagen denaturation and injuries in bipolar radiofrequency-induced colonic anastomoses

Bipolar radiofrequency-induced thermo-fusion has been explored as an advanced surgical method for intestinal anastomoses; however, the histological characteristics of collagen denaturation and injuries arising from this process remain unclear. The aim of this study was to investigate the microcosmic changes and tissue damage of fusion regions with various parameters of injury. Ex vivo colons of pigs were fused serosa-serosa on two carrier rings, which were installed on a homemade anastomotic device. Five levels of compressive pressure from 171 to 313kPa were applied for 5s to fuse the colons under radiofrequency power of 160W, and then the collagen denaturation of the fused region was examined by transmission electron microscopy. Light microscopy was utilized to observe histological slices that were stained with picrosirius red in order to visualize the tissue injuries under two levels of radiofrequency power (120 vs. 140W) and operation time (5 vs. 10s). Transmission electron micrographs showed that increased compressive pressure led to thicker denatured collagen fibrils and wider gaps between each collagen fibril. Serosa adhesion regions appeared abundant in collagen. No histological differences were observed when 120W of power was applied for 5 and 10s. Significant muscle cracking occurred when colons were fused using 140W for 5s. When the operation time was extended to 10s, 140W led to tight fusion and less splitting on muscles. These results suggest that higher compressive pressure results in more severe collagen unfolding and also reduces collagen crosslinking in fused colons. Improved radiofrequency power along with operation time could avoid tissue injury upon radiofrequency-induced colonic anastomoses.

The ROX coupler: creation of a fixed iliac arteriovenous anastomosis for the treatment of uncontrolled systemic arterial hypertension, exploiting the physical properties of the arterial vasculature.

Uncontrolled hypertension, whether due to drug resistance or poor adherence and persistence, remains a problem in many patients. The ROX coupler is a novel technology designed to reduce arterial blood pressure consequent to the predicted physical effects of reducing vascular resistance and improving arterial compliance. This article describes the technical aspects of the device and implantation procedure, results from a preclinical study, patient selection criteria, and potential complications of this therapy for uncontrolled hypertension. The coupler is a self-expanding, stent-like device that exploits the mechanical effects of the creation of a low-resistance, high-compliance venous segment to the central arterial tree, and can be implanted in a standard catheterization laboratory under fluoroscopic guidance. Preclinical studies were conducted in sheep with acute or chronic hypertension. The devices were implanted in the aorta for up to 12 months. The anastomoses were evaluated for patency, healing, conformation into the artery and vein, and complications. Deployment of the anastomotic device in ovine aortas for up to 12 months showed optimal anastomotic patency in all animals with proper healing and conformation of the device into the artery and the vein. There was no significant residual mural thrombus and minimal to moderate intimal thickening at the vein outflow, consistent with expected arterialization. A novel arteriovenous coupler for percutaneous placement in the iliac vasculature is under clinical investigation as a potential treatment modality for selected patients with uncontrolled hypertension. Initial results from patients with uncontrolled hypertension are expected in Autumn 2014.

Challenges facing totally endoscopic robotic coronary artery bypass grafting.

Robot-assisted surgery is growing in popularity; however, robotic totally endoscopic coronary artery surgery (TECAB) remains challenging, particularly in multi-vessel disease. A review of the current literature surrounding TECAB using the da Vinci® system. The da Vinci robot is the only commercially available system, operating on a master-slave paradigm with the surgeon controlling the robotic arms from a remote console. Robotic surgery today is presented with challenges, including dealing with a non-perfect robot without haptic control, a steep learning curve, lack of established training criteria and high cost. Strategies such as structured, simulated training and novel anastomotic devices may potentially shorten the learning curve, improve patency and facilitate grafting in multi-vessel disease. Future challenges will include the ability to demonstrate long-term patency, morbidity and mortality at least comparable to conventional CABG, whilst also offering cost effectiveness in this increasingly difficult economic environment.

Novel anastomotic techniques

Creating a safe and healthy bowel anastomosis remains critical for successful intestinal surgery. The selection of anastomotic technique depends on several factors, including the site of anastomosis, bowel caliber, tissue quality, and underlying disease process, but more importantly individual surgeon experience and personal preference play a major role. Other important key factors to a successful anastomosis are meticulous technique, good blood supply, and tension-free connection. However, despite the “perfect conditions” and technical advances some anastomoses continue to leak resulting in significant morbidity and mortality. Around 4% of all colonic anastomoses and even higher percentage of colorectal anastomoses leak; thus reducing this complication rate would improve mortality and health care costs. Many different techniques of colorectal anastomosis have been described in search for better outcomes and lower leak rates. In this article, I will discuss adjuncts to staplers with an emphasis on the compression anastomotic techniques and newer devices available, the potential advantages of intraoperative endoscopic evaluation of anastomosis, role of fluorescence imaging, and future directions in intestinal anastomotic technology.

Innovative Sutureless Microvascular Anastomotic Device With Embedded Doppler Flow Monitor1

Innovative Sutureless Microvascular Anastomotic Device With Embedded Doppler Flow Monitor1

Application of microvascular anastomotic device in vascular injury of upper limb

Objective To investigate the clinical outcomes of arteriovenous anastomosis by microvascular anastomotic coupler device.Methods From January 2013 to November 2013,23 cases of microvascular anastomotic coupler device were applied in 18 patients with vascular injury of upper limb,and anastomosis time and patency rate was observed.Results In 18 patients,the brachial artery injury in 2 cases,the radial artery injury in 11 cases,the ulnar artery injury in 8 cases,the cephalic vein injury in 1 case,and basilic vein injury in 1 case.23 microvascular anastomotic coupler devices were applied in vascular injury.The post procedure vascular patency rate was 100％ and the average time of anastomosis was 3min 59s.Conclusion Microvascular anastomotic coupler device is charactered by higher patency rate and faster operation.It can not only be used in venous anastomosis of tissue graft,and also has a certain value in the repair of arteriovenous injury. Key words: Vascular anastomosis; Upper limb; Microvascular anastomotic device; Thrombus

Clinical effect analysis of the limb blood vessel reconstruction with microvascular anastomotic devices

Objective Based on the review of our experience in the clinical treatment effects of blood vessel damage in limbs to evaluate the values in the suture method under microscope and microvascular anastomotic device of microvascular anastomosis.Methods The subjects were 45 consecutive patients who had undergone the vascular injury treatments in limbs in our hospital between February 2009 to October 2013.During the operations,two methods of the anastomoses were applied:suture method under microscope for 28 patients;microvascular anastomotic device for 17 patients.The patients in the group were drawn out to compare among the 2 methods of the microvascular anastomoses as following:the microscopic group and the anastomotic device group.The comparison included the total anastomosing time,the ischemia time and the complication incidence within the two groups.Results In the anastomotic device group,anastomosing time and the ischemia time (38.23 ± 4.32 minutes and 87.33 ± 4.16 minutes,respectively)was obviously shorter than that in the microscopic group (13.38 ±2.81 minutes and 25.23 ± 1.64 minutes,respectively).There was significant statistical difference between the two groups (P ＜ 0.05).The blood supply associate complication incidences was 30.1％ in the microscopic group,0 in the anastomoses group.Conclusion The usage of microvascular anastomotic device can significant shorten the anastomoses time and the ischemia time of the vascular injury treatments,decreased the complication incidence. Key words: Blood vessel damage; Limbs; Vascular anastomoses; Microvascular anastomotic device

The application of microvascular anastomotic device in microvascular anastomosis with diameter discrepancy

Objective To investigate the methods and efficacy of anastomosis between vessels with different diameterby using microvascular anastomotic device.Methods From February 2013 to June 2013,5 patients underwent five free-flap transfered with the use of the microvascular anastomotic device in 12 vessels anastomosis,which included 6 anastomosis with different luminal diameter between donor and recipient vessels.We performed vasoplasity via lateral incision or on the Y-shape branch of small-diameter vessels to enlarge the diameter of anastomotic stoma,then microvascular anastomosis device matched the larger-diameter vessel were used in the anastomosis.Conventional therapy of microvascular anastomosis was performed postoperatively.Results Six anastomoses (4 venous,2 arterial) were performed with the microvascular anastomotic device in anastomotic stoma with different luminal diameter between donor and recipient vessels,with diameter (0.8-1.5)mm in one side and 2.0-3.5 mm in the other side,which had ratio from 1.0 ∶ 1.5-1.0∶ 3.0.The end of small-diameter vessel could be everted over the pins of larger microvascular anastomosis device successfully via vasoplasity.The 2.0-3.5 mm microvascular anastomotic device implant was used in these cases.These anastomoses were successfully completed with microvascular anastomotic device without vessel shedding,blood leak intraoperatively and without vascular crisis postoperatively.The time taken to complete an end-to-end anastomosis with microvascular anastomotic device varied from 3-5 min.The followed-up time ranged from 1-3 months,and flap survival in the 5 patients was 100％.Conclusion It is a simple,fast and effective method to perform microvascular anastomosis using microvascular anastomotic device in anastomotic stoma with different luminal diameter through vasoplasity. Key words: Microvascular anastomotic device; Blood vessels; Vasoplasity; Free flap

End-to-end venous anastomosis using the microvascular anastomotic in head and neck detects reconstruction with free flaps

Objective To assess the reliability and useness of using a coupling device for end-to-end venous anastomosis in patients undergoing free-tissue transfer in head and neck reconstruction.Methods Twelve patients undergoing surgical resection and head and neck defects were repaired with fibular flap,anterolateral thigh flap and radial forearm flap.The microvascular anastomotic device was used to perform venous anastomosis in these cases.Flap survival and thrombosis of the venous anastomoses were determined.Results There were no flap losses due to venous thrombosis in this series.The venous anastomosis was usually coupled in about 5.3 minutes and appear as an obviously time savings compared with performing a hand-sewn venous anastomosis.Conclusion The microvascular coupler is excellent in end-to-end venous anastomosis and certainly less taxing on the surgeon when compared with standard suture techniques. Key words: Head and neck; Free flap; Microvascular anastomotic device; Venous anastomosis; Microsurgical technique

The preliminary application of microvascular anastomotic device for free flap transfer in head and neck cancer patients with locally advanced lesion

Objective To observe the effect of vein anastomosis by microvascular anastomotic device in head and neck reconstruction.Methods Sixteen cases needing free flaps were randomly selected in head and neck cancer patients with locally advanced lesion.Their veins were anastomosed by microvascular anastomotic device.Other 40 cases whose veins were anastomosed by manual anastomosis were selected as control during the same year.The statistical data of the time of veins anastomosis,thrombosis and the rate of flaps salvage were compared.Results The average time of venous anastomosis was 6.31 ± 0.87 minutes,which was lower than the manual anastomosis (19.20 ±4.62 minutes) significantly.There was no thrombosis,which was not significant different with the manual anastomosis.One case's venous blood flow was not smooth for the angled vein and the flap salvage operation was successful.Conclusion The time of venous anastomosis is shorten significantly by microvascular anastomotic device.The incidence of thrombosis is the same compared with venous anastomoses performed with sutures.The microvascular anastomotic device system allowed a time-efficient and safe venous anastomosis. Key words: Microvascular anastomotic device ; Free flap ; Microvascular anastomosis; Thrombus ; Complications

Incidence of Postoperative Stroke Using the Heartstring Device in 1,380 Coronary Artery Bypass Graft Patients With Mild to Severe Atherosclerosis of the Ascending Aorta

Atherosclerotic disease of the ascending aorta during coronary artery bypass graft surgery (CABG) increases the risk for postoperative stroke. The objective of this study was to examine the incidence of postoperative stroke in CABG utilizing the Heartstring (Maquet Cardiovascular, San Jose, CA) proximal anastomotic device. Intraoperative epiaortic ultrasonography was used to grade atherosclerosis in CABG patients at Emory University from April 2003 to December 2012. The Heartstring device was utilized in 1,380 patients: 407 (29.5%) grade I (minimal atherosclerosis), 367 (26.6%) grade II, 437 (31.7%) grade III, 110 (8.0%) grade IV, and 59 (4.3%) grade V (severe atherosclerosis). Logistic regression analysis was used to estimate the effect of aortic grade on outcomes adjusted for Society of Thoracic Surgeons predicted risk of mortality and predicted risk of stroke scores. The mean age of all patients was 66.7 ± 10.5 years, and 31.9% were female. An increasing risk profile was apparent with rising aortic grade. Most CABG was done off pump (n= 1,277, 92.5%). There was no significant association between aortic grade and frequency of postoperative stroke (p= 0.83). In all patients, use of the Heartstring device reduced the predicted risk of stroke by 44% (O:E risk 0.56). The benefit for postoperative stroke was least apparent in the grade I aorta patients (O:E 0.8) compared with patients having grade II and greater. There were no strokes among patients with severe atherosclerosis using the Heartstring device. Compared with the Society of Thoracic Surgeons predicted risk for stroke, the Heartstring proximal anastomotic device can be safely used with all aortic grades. The most prominent benefit appears to be for patients with grade II disease and greater.

Long-term follow-up of a novel anastomotic device in a canine model.

Construction of intestinal anastomosis is a fundamental general surgery skill. New constraints in creating safe, effective anastomoses are faced, however, even as minimally invasive surgery techniques continue to gain popular and scientific support. We present our experience in developing and testing a novel anastomotic device (AD) constructed of a shape memory metal, with long-term follow-up in a canine model. This device has the potential for both laparoscopic and endoscopic delivery because of its unique design and adaptable deployment system. Eight canines had gastroduodenal and jejunojejunal anastomoses formed with the AD: the gastroduodenal anastomosis by transecting the stomach immediately distal to the pylorus and forming a side-to-side functional end-to-end anastomosis and the jejunojejunal anastomosis similarly following transection in the mid-jejunum. Four animals were survived for 6 months, and 4 for 12 months. At the study's end, the animals were euthanized and the anastomotic sites harvested for both gross and microscopic pathology. Two animals developed postoperative complications: one a mechanical bowel obstruction from bedding ingestion that required laparotomy, and one an ileus that conservative management resolved. All animals survived to their endpoints, displaying normal growth and development. All jejunojejunal anastomoses had AD passage and microscopic evidence of complete healing. Meanwhile, none of the gastroduodenal devices passed, with microscopy demonstrating incomplete mucosalization. This AD is highly effective in forming jejunojejunal anastomoses. Gastroduodenal anastomoses, while highly functional, retained the device without complete healing. Future studies using a more human-like animal model and an anastomotic technique avoiding the thick pylorus muscle should yield better results.

Influencing Factors for Early Acute Cerebrovascular Accidents in Patients with Stroke History following Off-pump Coronary Artery Bypass Grafting

To analyse risk factors for early acute cerebrovascular accidents following off-pump coronary artery bypass grafting (OPCAB) in patients with stroke history, and to propose preventive measures to reduce the incidence of these events. A total of 468 patients with a history of stroke underwent OPCAB surgery in Beijing Anzhen Hospital of China from January 2010 to September 2012. They were retrospectively divided into two groups according to the occurrence of early acute cerebrovascular accidents within 48 hours following OPCAB. Multivariate logistic regression analysis was used to find risk or protective factors for early acute cerebrovascular accidents following the OPCAB. Fifty-two patients (11.1%) suffered from early acute cerebrovascular accidents in 468 patients, including 39 cases of cerebral infarction, two cases of cerebral haemorrhage, 11 cases of transient ischaemic attack (TIA). There were significant differences between the two groups in preoperative left ventricular ejection fraction ≤ 35%, severe bilateral carotid artery stenosis, poorly controlled hypertension, intraoperative application of Enclose® II proximal anastomotic device, postoperative acute myocardial infarction, atrial fibrillation, hypotension, ventilation time > 48h, ICU duration >48h and mortality. Multivariate logistic regression analysis showed that preoperative severe bilateral carotid stenosis (OR=6.378, 95%CI: 2.278-20.987) and preoperative left ventricular ejection fraction ≤ 35% (OR=2.737, 95%CI: 1.267-6.389), postoperative acute myocardial infarction (OR=3.644, 95%CI: 1.928-6.876), postoperative atrial fibrillation (OR=3.104, 95%CI:1.135∼8.016) and postoperative hypotension (OR=4.173, 95%CI: 1.836∼9.701) were independent risk factors for early acute cerebrovascular accidents in patients with a history of stroke following OPCAB procedures, while intraoperative application of Enclose® II proximal anastomotic device was protective factor (OR=0.556, 95%CI: 0.337-0.925). This study indicated that patients with severe bilateral carotid stenosis, the left ventricular ejection fraction ≤35%, the postoperative acute myocardial infarction, postoperative atrial fibrillation and postoperative hypotension were more likely to suffer from early acute cerebrovascular accidents when they received OPCAB. Application of Enclose® II proximal anastomotic device may decrease the incidence of early acute cerebrovascular accidents during OPCAB.

A modular magnetic anastomotic device for minimally invasive digestive anastomosis: proof of concept and preliminary data in the pig model

The aim of our study was to assess the feasibility of minimally invasive digestive anastomosis using a modular flexible magnetic anastomotic device made up of a set of two flexible chains of magnetic elements. The assembly possesses a non-deployed linear configuration which allows it to be introduced through a dedicated small-sized applicator into the bowel where it takes the deployed form. A centering suture allows the mating between the two parts to be controlled in order to include the viscerotomy between the two magnetic rings and the connected viscera. Eight pigs were involved in a 2-week survival experimental study. In five colorectal anastomoses, the proximal device was inserted by a percutaneous endoscopic technique, and the colon was divided below the magnet. The distal magnet was delivered transanally to connect with the proximal magnet. In three jejunojejunostomies, the first magnetic chain was injected in its linear configuration through a small enterotomy. Once delivered, the device self-assembled into a ring shape. A second magnet was injected more distally through the same port. The centering sutures were tied together extracorporeally and, using a knot pusher, magnets were connected. Ex vivo strain testing to determine the compression force delivered by the magnetic device, burst pressure of the anastomosis, and histology were performed. Mean operative time including endoscopy was 69.2 ± 21.9 min, and average time to full patency was 5 days for colorectal anastomosis. Operative times for jejunojejunostomies were 125, 80, and 35 min, respectively. The postoperative period was uneventful. Burst pressure of all anastomoses was ≥ 110 mmHg. Mean strain force to detach the devices was 6.1 ± 0.98 and 12.88 ± 1.34 N in colorectal and jejunojejunal connections, respectively. Pathology showed a mild-to-moderate inflammation score. The modular magnetic system showed enormous potential to create minimally invasive digestive anastomoses, and may represent an alternative to stapled anastomoses, being easy to deliver, effective, and low cost.

Anastomotic devices in coronary artery surgery: it is about the anastomosis?

Excellent long-term graft patency remains the primary goal of any surgical coronary revascularization procedure, irrespective of how the operation itself is performed. Inter- and intra-surgeon variability in the surgical technique and in the subsequent quality of the anastomosis have the potential to significantly impact not only on graft patency but also, as a result, on patient outcomes. Anastomotic devices, proximal and distal, can facilitate the creation of rapid, reproducible, compliant anastomoses, on- or off-pump, in potentially difficult-to-access areas, often through minimal-access incisions, potentially with neuro-protective benefits, and can thus mitigate some of the hazards inherent in manually constructing anastomoses in technically challenging or suboptimal conditions. We review the three most commonly employed anastomotic devices in adult cardiac surgical practice today.

Magnets in the GI tract

Magnets in the GI tract

The nonocclusive laser-assisted coronary anastomotic connector in an off-pump porcine bypass model

To facilitate minimally invasive coronary artery bypass grafting, a simplified alternative for hand-sutured anastomoses must be developed. We assessed the feasibility and anastomotic healing of the ameliorated Excimer laser-assisted nonocclusive anastomosis coronary prototype connector in an acute rabbit study (study 1) and in a long-term porcine off-pump coronary bypass study (study 2). Eighteen anastomoses were constructed on the abdominal aorta of the rabbit. In the porcine model, 15 left internal thoracic artery to left anterior descending coronary artery bypasses were evaluated intraoperatively and at 4 hours, 4 and 10 days, 2, 3, and 5 weeks, and 6 months (each n=2 anastomoses). The anastomoses were examined by angiography, flow measurements, fractional flow reserve, coronary flow reserve, histologic features, and scanning electron microscopy. In study 1, all 18 anastomoses were patent and resisted supraphysiologic pressures (n=12, 300 mm Hg). In study 2, the connector enabled nonocclusive and fast (7.7 ± 2.2 minutes, mean ± standard deviation) anastomosis construction. All but 1 of 15 anastomoses (owing to a technical error) were fully patent (FitzGibbon grade A) at follow-up. Histologic examination and scanning electron microscopy demonstrated complete endothelialization of the anastomoses at 10 days. At 6 months, no flow-limiting but streamline-covering intimal hyperplasia was shown (fractional flow reserve, 0.93 ± 0.07 mean ± standard deviation). The new nonocclusive coronary connector is easy to use, and the long-term results suggest favorable healing and remodeling in the porcine model. After downsizing, this anastomotic device, with its emphasis on zero ischemia and simplified prebounding of vessel walls, has intrinsic potential for minimally invasive off-pump coronary artery bypass surgery.

Anastomotic leakage after low anterior resection for rectal cancer: comparison of stapled versus compression anastomosis

Surgical technique and perioperative management in rectal cancer surgery have been substantially improved and standardized during the last decades. However, anastomotic leakage following low anterior resection still is a significant problem. Based on animal experimental data of improved healing of compression anastomosis, we hypothesized that a compression anastomotic device might improve healing rates of the highest-risk anastomoses. All low anterior resections for rectal cancer performed or directly supervised by the senior author between January 2004 and June 2012 were analyzed. Only patients with a stapled or compression anastomosis located within 6cm from the anal verge were included. Until December 2008, circular staplers were employed, while since January 2009, a novel compression anastomotic device was used for rectal reconstruction exclusively. Out of 197 patients operated for rectal cancer, a total of 96 (34 females, 35.4%) fulfilled inclusion criteria. Fifty-eight (60.4%) were reconstructed with circular staplers and 38 (39.6%) using a compression anastomotic device. Significantly, more laparoscopic procedures were recorded in the compression anastomosis group, but distribution of gender, age, body mass index, American Society of Anaesthesiologists score, rate of preoperative radiotherapy, tumor staging, or stoma diversion rate were similar. Anastomotic leakage was observed in seven cases (7/58, 12.1%) in the stapled and twice (2/38, 5.3%) in the compression anastomosis group (p = 0.26). In this series, rectal reconstruction following low anterior resection using a novel compression anastomotic device was safe and (at least) equally effective compared to traditional circular staplers concerning leak rate.