Compression Anastomosis Research Articles

Su1402 EFFICACY AND SAFETY OF EUS-GUIDED ANTEGRADE INTERVENTION FOR BENIGN BILIARY DISEASE WITH SURGICAL ALTERED ANATOMY

The efficacy and safety of balloon enteroscopy-assited ERCP (BE-ERCP) for benign biliary diseases such as anastomotic stricture or bile duct stone in patients with surgically altered anatomy has been reported. However, the scope insertion or the selective biliary cannulation is not always successful. Traditionally, percutaneous intervention has been performed as an alternative procedure when BE-ERCP fails or is not available. However, the percutaneous management during the long period may lead more burden to patients with benign biliary diseases. Recently, antegrade intervention via the fistula created by EUS-guided biliary drainage（EUS-guided antegrade intervention：EUS-AI）has been one of options. The aim of this present study is to show the outcome of EUS-AI in patients with surgically altered anatomy. From November 2013 to November 2017 at Tokyo Medical University Hospital, 34 patients with surgically altered anatomy (15 men and 19 women; median age 64 years; range 22-90), whom EUS-AI were attempted, were retrospectively evaluated. The benign biliary diseases included intrahepatic bile duct stones (n=6), common bile duct stones (n=10), and anastomotic stricture (n=18) (10 cases were complicated by stones). The technical success rate of EUS-BD constructing the access route for the bile duct was 91% (31/34, HGS 27 cases, HJS 3 cases, CDS 1 case). The placed stent included 8Fr dedicated plastic stent for EUS-HGS (n=27), biliary metal stent (n=3), and lumen-apposing metal stent (n=1). Of 3 cases with the difficulty of EUS-BD due to the thin bile duct, in one case EUS-rendezvous was performed, resulting the success of stone removal, in another two cases observational management was selected. The moderate adverse events were observed in two cases [ 5.9%, biliary peritonitis (n=2)]. Of 31 cases of successful EUS-BD, the antegrade interventions were performed at the same time of EUS-BD in 7 cases (22.6%) and at about one or two months later date in 24 cases (77.4%). The antegrade interventions by only procedure under fluoroscopy were succeeded in 13 cases (41.9%). The procedures under cholangioscopy inserted via the fistula were required in 17 cases [54.8%, break through the severe stricture of anastomosis (n=4), electorohydraulic lithotripsy (n=13)]. In one case, the magnetic compression anastomosis was performed via the HGS route. In one case, the percutaneous approach for the right intrahepatic bile duct was required. Of 31 cases, complete stone removal or treatment for anastomotic stricture by EUS-AI was achieved in all patients (100%) with no adverse event. EUS-AI is technically safe and effective for benign biliary diseases in patients with surgically altered anatomy. It should be taken into consideration as an alternative procedure when BE-ERCP is difficult.

PREVENTION OF SMALL INTESTINE BACTERIAL OVERGROWTH SYNDROME AFTER RIGHT HEMICOLECTOMY FOR COLON CANCER

Background. One of the reasons of the small intestinal bacterial overgrowth syndrome (SIBOS) is excision of a bauginiyev valve at a rightsided hemicolectomy both in planned and in the emergency order that demands not only restoration of continuity of an intestinal tube, but also a restore of the lost function of the ileocecal valval system. Objective: to develop safe, effective and generally available areflux thin-colonic anastomoses for use in planned (primary anastomosis) and emergency (delayed compression anastomosis) surgery. Materials and methods . New ways of formation the areflux thin-colonic anastomoses in the conditions of the emergency and planned surgery for prophylaxis of development of the SIBOS in a small intestine are suggested. The efficacy of the anastomoses is confirmed by the hydrogen breathing test. Results . A right-sided hemicolectomy at 20 patients with primary anastomosis without areflux structure resulted in 60 % of cases to development of SIBOS in a small intestine, at 19 patients with primary anastomosis with formation of the areflux structure reduced risk of development of the SIBOS to 16 %. When forming of the delayed areflux compression thin-colonic anastomosis by the author’s technique the SIBOS did not develop at 72 % of patients. Conclusions . Bauginiyev valve is an important structure of the human body, whose areflux function must be modeled when right-sided hemicolectomy is performed.

Effectiveness of gastroduodenostomy created with the use of shape memory compression anastomosis clips: observations in a porcine model

This article evaluates the effectiveness of gastroduodenostomies created with the use of shape memory compression anastomosis clips (CAC) and compares the surgical outcomes with those of hand-sewn anastomoses. We performed Billroth’s operation I in eight pigs: shape memory compression clips were used in six animals and hand-sewn anastomoses were created in two animals. Postoperative complications such as leakage or obstructed passage of digesta were not observed in any of the patients. Pathomorphological examinations and histopathological analyses confirmed that all anastomoses were tight and that gastroduodenal continuity was fully restored. In comparison with hand-sewn anastomoses, compression clips shortened the time of the surgical procedure and proved to be a safe, effective and low-cost technique for performing Billroth’s operation I in animals. The experience and knowledge acquired during the experiment will be used to maximise the effectiveness of gastroduodenostomy in canine and feline patients.

СПОСОБ ФОРМИРОВАНИЯ БИЛИОДИГЕСТИВНЫХ АНАСТОМОЗОВ С ИСПОЛЬЗОВАНИЕМ КОМПРЕССИОННОГО УСТРОЙСТВА ИЗ НИКЕЛИДА ТИТАНА

In our research, we evaluated the effectiveness of the device for the valve compression anastomoses formation in animals. The implant is made of the titanium nickelide alloy (TiNi) in the form of two loops of the TiNi wire. In the area of the bent turns, compression is not carried out, the tissue is not squeezed, and later the valve is formed in the zone of anastomosis. Twenty-six antireflux biliodigestive compression anastomoses on the small bowel have been created during the experiment. They include 13 choledochojejunostomies and 13 cholecystojejunostomies. We studied the terms of the compression devices failure, the mechanical and biological durability of these anastomoses, the primary permeability of anastomoses and carried out the microscopic examination of the compression suture. We proved that all valve compression anastomoses created with TiNi shape-memory implant have been mechanically and biologically tight. The compression devices were eliminated from the zones of anastomoses on the 7th-8th day after the surgery in all cases. The microscopic examination showed the insignificant development of sclerosis in the compression zone and full adaptation of all organ layers. The created valve reduced the reflux of intestinal contents that lessened the probability of development of acute and chronic cholangitis in the postoperative period. The use of the TiNi implant allows to carry out the operation twice quicker. Such anastomosis has high physical durability and low bacteriological permeability. The new way of the formation of valve biliodigestive compression anastomoses allows to create stronger and more reliable anastomoses and prevent the development of typical complications.

Compression anastomoses with nikelid-titanium rings in peritonitis

To introduce into clinical practice compression anastomosis with nikelid-titanium rings (NTR) with shape memory in advanced peritonitis patients who need for intestinal resections. Seventy-six procedures of interintestinal anastomoses with NTR (Günter-Ziganshin implant) have been analyzed for the period 2011-2017. Interventions were carried out for widespread peritonitis. In all cases a unified technique of anastomosis was used by applying an implant in the form of a 'clerical clip'. There were following procedures: gastroenterostomy resection for its failure - 5; small intestine resection followed by interntestinal anastomosis - 36; ileotransverso- or colocolostomy - 35. Mean time of enteroenterostomy was 2.6±0.98 min. If elective re-laparomy was supposed, laparostomy was formed followed by sanation within 48 hours. In 55% of patients 3-5-fold elective sanations were performed. Adequacy of compression anastomoses was assessed clinically according to the nature of drainage output and visually during redo surgery. There were 11 (14.5%) deaths: 9 (12%) patients had APACHE-II score over 20. Macro- and microscopic analysis of intestinal specimens and interintestinal anastomoses with nikelid-titanium rings showed complete impermeability and no visual defects. Microscopically neutrophilic leukocyte infiltration and increased number of fibroblasts were observed as the evidence of regenerative processes activation. Implant rejection time was 7.8±1.4 days. The use of compression anastomoses in case of advanced peritonitis reduces the risk of anastomosis failure to 3% and decreases time of surgery that reduces intraoperative aggression and improves outcomes in patients with prognostically unfavorable outcomes.

Evolution and prospect of colorectal anastomosis

Colorectal cancer is the third most common malignant tumor among men, and the second most common malignant tumor among women worldwide. As one of the most common malignant tumor, colorectal cancer has a great threat to the health of people. Although the development of radiotherapy and chemotherapy could improve the prognosis of colorectal cancer, surgery, the complete resection of the tumor, remains the only chance for the cure of this disease. Over the past hundred years, surgical oncology went in the direction of protecting organ function and improving quality of life. Anus-preserving surgery for low rectal cancer and laparoscopic colorectal surgery are exactly following this tendency. In colorectal surgery, surgeons need to perform intestinal anastomosis and recover the intestinal continuity after the excision of the abnormal bowel, thus a series of colorectal anastomosis techniques occur, including manual anastomosis, stapled anastomosis, compression anastomosis, and radiofrequency-induced thermo-fusion of intestinal anastomoses, which is currently being studied by many researchers at home and abroad. Manual anastomosis is divided into single- and two-layer anastomosis, continuous and interrupted sutures, and inverting and everting sutures performed in different ways. In this paper, we offer an overview of evolution, evaluate the safety and effectiveness, and compare the incidence of complications, particularly anastomotic leakage and anastomotic stenosis of different anastomotic techniques. After the objective elucidation of advantages and disadvantages, we are also looking forward to better colorectal anastomosis techniques in the future.

Magnetic compression anastomosis for obstructed choledocho-jejunostomy

Magnetic compression anastomosis for obstructed choledocho-jejunostomy

Successful Treatment of Stricture of Duct-to-Duct Biliary Anastomosis After Living-Donor Liver Transplantation of the Left Lobe: A Case Report

Biliary complications, such as stricture or obstruction, after living-donor liver transplantation (LDLT) remain major problems to be solved. Magnetic compression anastomosis (MCA) is a minimally invasive method of biliary anastomosis without surgery in patients with biliary stricture or obstruction. A 66-year-old woman had undergone LDLT for end-stage liver disease for primary biliary cholangitis 20 months previously at another hospital. Computerized tomography showed dilation of the intrahepatic bile duct (B2). Because B2 was invisible with the use of endoscopic retrograde cholangiopancreatography, percutaneous transhepatic biliary drainage (PTBD) was performed for treatment of cholangitis. The rendezvous technique failed because a guidewire could not pass through the biliary stricture. Therefore, we decided to perform MCA. A parent magnet was endoscopically placed distally in the common bile duct of the stricture, and a daughter magnet attached to a guidewire was inserted proximally through the fistula tract of the PTBD. Both magnets were positioned across the stricture, and the 2 magnets were pulled to each other by magnetic power, to sandwich the stricture. By 14 days after MCA, a fistula between B2 and the common bile duct was created. At 28 days after MCA, the magnets were removed distally and a 16-French tube was placed across the fistula. At 7 months after MCA, that tube was removed. In conclusion, when a conventional endoscopic or percutaneous approach including the rendezvous technique fails, MCA is a good technique for biliary stricture after LDLT.

Magnetic Compression Anastomosis (Magnamosis): First-In-Human Trial

Magnetic compression anastomosis (magnamosis) uses a pair of self-centering magnetic Harrison Rings to create an intestinal anastomosis without sutures or staples. We report the first-in-human case series using this unique device. We conducted a prospective, single-center, first-in-human pilot trial to evaluate the feasibility and safety of creating an intestinal anastomosis using the Magnamosis device. Adult patients requiring any intestinal anastomosis to restore bowel continuity were eligible for inclusion. For each procedure, 1 Harrison Ring was placed in the lumen of each intestinal segment. The rings were brought together and mated, and left to form a side to side, functional end to end anastomosis. Device movement was monitored with serial x-rays until it was passed in the stool. Patients were monitored for adverse effects with routine clinic appointments, as well as questionnaires. Five patients have undergone small bowel anastomosis with the Magnamosis device. All 5 patients had severe systemic disease and underwent complex open urinary reconstruction procedures, with the device used to restore small bowel continuity after isolation of an ileal segment. All devices passed without obstruction or pain. No patients have had any complications related to their anastomosis, including anastomotic leaks, bleeding, or stricture at median follow-up of 13 months. In this initial case series from the first-in-human trial of the Magnamosis device, the device was successfully placed and effectively formed a side to side, functional end to end small bowel anastomosis in all 5 patients. No patients have had any anastomotic complications at intermediate follow-up.

Magnetic Compression Stricturoplasty For Treatment of Refractory Esophageal Strictures in Children: Technique and Lessons Learned.

Esophageal stricture is the most common complication following repair of esophageal atresia (EA). In general, these strictures are successfully managed using endoscopic techniques including bougie and balloon dilation, stenting, and chemotherapeutic agent application. If these techniques are unsuccessful, patients require segmental esophageal resection and reanastomosis or esophageal replacement. Magnetic compression anastomosis has been described in children. Herein we report our experience with magnetic compression stricturoplasty to treat refractory strictures after EA repair. We reviewed our experience using magnets to treat refractory strictures in 2 patients. Both patients failed multiple standard interventions. Because of near complete esophageal obstruction, both patients were candidates for esophageal replacement or segmental resection/anastamosis. In both patients, we applied neodymium-iron-boron magnets using fluoroscopic and endoscopic guidance. The magnets were successfully positioned in both cases. Magnets were left in place for 7 and 10 days allowing for gradual compression stricturoplasty/anastamosis. Upon removal of the magnets, recanalization was visualized endoscopically and self-expanding stents were placed. There were no leaks or significant early complications. By 31 months post-magnetic stricturoplasty, both patients achieved durable esophageal patency without dysphagia. Magnetic stricturoplasty was successful at establishing early patency of the esophagus in 2 patients with recalcitrant EA strictures. Fundamental knowledge of magnetism was critical in configuring magnet arrays for surgery. In both cases, early follow-up is promising. Further follow-up will define the long-term success of this technique.

Antireflux Compression Biliodigestive Anastomoses Formation with the Usage of the TiNi Shape Memory Implant

The usefulness of the anastomotic device for the valve compression anastomoses formation among animals was evaluated. The implant is made of the nickelid titanium alloy (TiNi) in the form of two rounds of the TiNi wire which ends are unbent to the opposite sides. In the area of the unbent rounds the compression isn't carried out, the tissue isn't squeezed. And further there is a formation of the valve. 26antirefluxbiliodigestive compression anastomoses on the small bowel are created during the experiment. They include 13 choledochojejunostomy and 13 cholecystojejunostomy. We studied the terms of the compression devices failure, the mechanical and biological durability of these anastomoses, the primary permeability of anastomoses and carried out the microscopic examination of the compression suture. No complications connected with the use of the compression device were noted. We proved that all the valve compression anastomoses created with using the TiNi shape-memory implant are mechanically and biologically tight. The compression devices eliminated from the zones of anastomoses on the 7th-8th day after the surgery in all cases. The microscopic examination showed the insignificant development of sclerosis in the compression zone and full adaptation of all organ layers. The created valve reduced the reflux of intestinal contents that lessened the probability of development of acute and chronic cholangitis in the postoperative period. The use of the TiNi implant allows to carry out the operation twice quicker. Such anastomosis has high physical durability and small bacteriological permeability.The new way of the formation of valve biliodigestive compression anastomoses allows to create stronger and more reliable anastomoses and prevent the development of typical complications.

Compression Anastomoses Formation on the Digestive Tract Organs with Using TiNi Devices

The article contains the results of a study of nickelid titanium devices used for the formation of compression anastomoses in patients with digestive system diseases and describes the techniques of compression fistula formation using these devices. Besides, the article presents clinical experience in the formation of anastomoses between the organs of gastrointestinal tract for the treatment of eighty-seven patients with various pathologies of digestive organs. One hundred and nine compression anastomoses were applied in our clinic. Anastomotic dehiscence was found in three cases (2,7%) which are described in details in the article. In all patients, the devices evacuated from the digestive tract in a natural way. The average period of device rejection accounted for 14 days. Fibrotic scope examination performed after an operation showed that created anastomoses corresponded to the dimensions of used structures. A soft scar by primary healing type was formed on the parts with compression anastomosis. Using nickelid titanium devices for the formation of compression anastomoses between the gastrointestinal organs will improve the quality of fistula formation, reduce mortality and postoperative complications.

Sutureless Compression Anastomoses Formation with Use of TiNi Device on the Small Gut

A new device made of nickelid titanium and a way of formation of a sutureless compression anastomosis on the small bowel were developed with the purpose of creating a compression interintestinal anastomosis on the small bowel without the manual portion of seams. 28 sutureless compression anastomosis on the small bowel are created during the experiment. They include 10 «side-to–side» anastomoses, 10 «end-to-end»anastomoses and 8 «end-to-side» anastomoses. Mechanical and biological durability of anastomoses, terms of compression devices failure, primary permeability of anastomoses, morphogenesis of a compression seam are studied. No complications connected with the use of the compression device were noted. During the experiment it is proved that all sutureless compression anastomoses created by means of the nickelid titanium device are mechanically and is biologically tight. By the ninth day all the dogs had no compression devices in their abdominal cavities. The histological researches show that the process of neogenesis goes with the minimal symptoms of sclerosis and leads to the full adaptation of all small bowel layers. The new way of the formation of a sutureless compression anastomosis on the small bowel allowed to create a stronger and more reliable anastomosis and thereby to prevent the development of typical complications and to receive more favorable remote results.

Influence of multiple stapler firings used for rectal division on colorectal anastomotic leak rate

BackgroundAnastomotic leakage following colorectal resection remains one of the most significant complications with relevant morbidity and mortality. There is evidence that a higher number of stapler firings for rectal division can affect the leak rate in double stapling anastomosis. However, there are no data concerning compression anastomosis. We present our institutional experience addressing this issue.DesignThis is a retrospective review of a prospective institutional database of patients undergoing colonic and rectal resection for benign and malignant indications between January 2008 and December 2014 at the surgical department of the St. John of God Hospital, Vienna. Inclusion criteria were rectal division with linear stapling devices and construction of anastomosis to the rectal stump using a circular stapler or compression device.ResultsThree hundred eighty two (196 female; 51.3%) patients were included. Mean age was 65.8 years (range: 18–95) Indications for the operation included diverticular disease (44.8%), colorectal carcinoma (51.6%), inflammatory bowel disease (1.8%), and adenoma (1.8%). A laparoscopic approach was employed in 334 cases (87.4%); in 170 patients (44.9%), a compression anastomosis was created. One, two, and three or more stapler cartridges were used for rectal division in 58.4, 33.5, and 8.1%, respectively. Male gender, neoadjuvant therapy, rectal cancer as an underlying disease, laparoscopic surgical approach, and duration of operation longer than 200 min are leading causes for the usage of more than one stapler cartridge. Overall leak rate was 4.7% (18/382). The only factor associated with the occurrence of leakage was the use of three or more stapler cartridges for the closure of the rectal stump (p = 0.002).ConclusionOur data support that multiple stapler firings for rectal division following colorectal resection has a major impact on anastomotic leak rate. Especially in laparoscopic surgery efforts should be made to minimize the number of stapler cartridges used.

Biliary-duodenal anastomosis using magnetic compression following massive resection of small intestine due to strangulated ileus after living donor liver transplantation: a case report

BackgroundDespite the improvements of surgical techniques and postoperative management of patients with liver transplantation, biliary complications are one of the most common and important adverse events. We present a first case of choledochoduodenostomy using magnetic compression following a massive resection of the small intestine due to strangulated ileus after living donor liver transplantation.Case presentationThe 54-year-old female patient had end-stage liver disease, secondary to liver cirrhosis, due to primary sclerosing cholangitis with ulcerative colitis. Five years earlier, she had received living donor liver transplantation using a left lobe graft, with resection of the extrahepatic bile duct and Roux-en-Y anastomosis. The patient experienced sudden onset of intense abdominal pain. An emergency surgery was performed, and the diagnosis was confirmed as strangulated ileus due to twisting of the mesentery. Resection of the massive small intestine, including choledochojejunostomy, was performed. Only 70 cm of the small intestine remained. She was transferred to our hospital with an external drainage tube from the biliary cavity and jejunostomy. We initiated total parenteral nutrition, and percutaneous transhepatic biliary drainage was established to treat the cholangitis. Computed tomography revealed that the biliary duct was close to the duodenum; hence, we planned magnetic compression anastomosis of the biliary duct and the duodenum. The daughter magnet was placed in the biliary drainage tube, and the parent magnet was positioned in the bulbus duodeni using a fiberscope. Anastomosis between the left hepatic duct and the duodenum was accomplished after 25 days, and the biliary drainage stent was placed over the anastomosis to prevent re-stenosis. Contributions to the successful withdrawal of parenteral nutrition were closure of the ileostomy in the adaptive period, preservation of the ileocecal valve, internal drainage of bile, and side-to-side anastomosis.ConclusionsCholedochoduodenostomy with magnet compression could be a less invasive and safer method for treatment of biliary stricture that cannot be accessed by conventional surgery.

An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications.

Biliary complications are the most common post-liver transplant (LT) complications with an incidence of 15%–45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT compared to a deceased-donor LT. Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques—such as the rendezvous method, magnetic compression anastomosis , and peroral cholangioscopy—combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.

Management of biliary anastomotic strictures after liver transplantation.

Biliary strictures constitute 40% to 60% of the biliary complications after liver transplantation. They are more common after living donor related liver transplantation (LDLT) than orthotopic liver transplantation (OLT). Balloon dilation followed by multiple plastic stent insertion leads to a mean resolution rate of 84% in the treatment of ASs after OLT. Endoscopic treatment of ASs after LDLT is more difficult because of the small size of the ASs, their multiple number and peripheral location. Balloon dilation followed by multiple plastic stent insertion had a mean resolution rate of 53%. Percutaneous transhepatic biliary drainage was required in 16% to 44% of the patients. Refractory cases with complete biliary obstruction and severe stenosis, in whom the stricture could not be traversed with a guidewire, can be treated by magnetic compression anastomosis as a rescue therapy, if the anatomy of the bile ducts is suitable. In this review, we will focus on the endoscopic treatment of ASs, with special emphasis to refractory cases.

Experimental Procedure of Compression Anastomosis Using Fragmented Rings: A Porcine Model.

Compression anastomosis has been recently abandoned because of a nonsuperiority compared to stapling anastomosis. Nonremoval of the rings has frequently been reported and this technique does not support a routine use. The aim of this experimental study was to assess the feasibility of anastomosis using compression with a device consisting of fragmented rings. A new compression device, the "Anastocom," was compared to standard double-stapled colocolonic anastomosis in 2 groups of 8 pigs. In each group, colocolonic anastomosis was performed with a circular stapler (DST Series EEA Staplers) in 4 pigs and with the Anastocom device for the other 4 pigs. The anastomotic rings were expelled between postoperative day 7 and day 13 from the 4 animals sacrificed at day 30. The anastomosis was clean and intact in all pigs. After sacrifice, there was no difference in the bursting pressure at day 7 ( P = .226) or at day 30 ( P = .885) between the 2 types of anastomosis. After sacrifice at day 7, the mean bursting pressure values for the Anastocom and EEA anastomoses were 128.6 mm Hg (range 119-143 mm Hg) and 218.9 mm Hg (range 84-240 mm Hg), respectively. After sacrifice at day 30, the mean bursting pressure values for the Anastocom and EEA anastomoses were 111 mm Hg (range 59-234 mm Hg) and 105 mm Hg (range 81-130 mmHg), respectively. No bowel obstruction was observed with Anastocom. This fragmentation mechanism should better prevent nonexpulsion compared to basic compression anastomosis.

A systematic analysis of controlled clinical trials using the NiTi CAR™ compression ring in colorectal anastomoses.

Anastomotic leak following colorectal surgery can be a devastating adverse event. The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction which potentially contribute to early anastomotic dehiscence or late anastomotic stricture. A systematic review was performed examining available data on controlled randomized and non-randomized trials assessing the NiTi compression anastomosis ring-(NiTi CAR™) (NiTi Solutions, Netanyah Israel) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. A protocol for this meta-analysis has been registered on PROSPERO (CRD42016050934). The initial search yielded 45 potentially relevant articles. After screening titles and abstracts for relevance and assessment for eligibility, 39 of these articles were eventually excluded leaving 6 studies for analysis in the review. Regarding the primary outcome measure, the overall anastomotic leak rate was 2.2% (5/230) in the compression anastomosis group compared with 3% (10/335) in the conventional anastomosis group; this difference was not statistically significant (RR 0.75, 95% CI 0.25-2.24; participants=565; studies=6; I 2=0%). There were no statistically significant differences between compression and conventional anastomoses in any of the secondary outcomes. This review was unable to demonstrate any statistically significant differences in favor of the compression anastomosis technique over conventional manual or stapled mechanical anastomoses.

Colorectal anastomosis using a compression device

Abstract Background The most severe complication following an intestinal anastomosis is the dehiscence with the consequent development of sepsis, fistulas, stenosis, and death. For this reason the compression anastomosis (NiTi) system was developed, with the aim of reducing these complications. Material and methods A retrospective study was conducted, from 1 June 2012 to 30 August 2014, on total of 14 patients operated on the Humanitas Hospital Medical Group Coyoacan, the ASMED, and Clinica Medica Sur. The subjects were predominantly male 65%, a mean age of 58 years, with range 30–79 years. Results A total of 14 patients were included. The indication for surgery was complicated diverticular disease Hinchey II–III (36%), and the procedures performed were: 6 (43%) left hemicolectomy with primary end to end compression anastomosis, 2 (14%) major complications (dehiscence wall and anastomosis), 1 (7%) minor complication (infection of the soft tissues). There was a mean 98 ml (range 20–300 ml) of intraoperative bleeding, with start of oral feeding on the second day, a mean hospital stay of 4 days (range 2–10), one patient with ileo-rectal anastomosis dehiscence presented on the 4th post-operative day, and performing anastomosis with stapling device and loop ileostomy. Stenosis developed in 7% during follow-up and was resolved with a new anastomosis stapler. Conclusions The NiTi device is an additional alternative for colorectal anastomosis, mainly in low anastomosis, obtaining good results in this study without major complications.