Vilhjalmsson Dadi, Appelros Stefan, Toth Ervin, Syk Ingvar, Grönberg Anders, Mynster Tommie, Thorlacius Henrik
Department of Clinical Sciences, Section of Surgery, Lund University, 205 02, Malmö, Sweden.
Int J Colorectal Dis. 2015 Jul;30(7):969-75. doi: 10.1007/s00384-015-2257-z. Epub 2015 May 20.
Compression anastomotic ring-locking procedure (CARP) is a novel procedure for creating colonic anastomoses. The surgical procedure allows perioperative quantification of the compression pressure between the intestinal ends within the anastomosis and postoperative monitoring of the anastomotic integrity. We have recently shown that CARP is a safe and effective method for colonic anastomoses in pigs, and the purpose of the present study was to evaluate CARP for colonic anastomoses in humans.
This is a prospective study on 25 patients undergoing elective left-sided colonic resection. Time for evacuation of the anastomotic rings, perioperative compression pressure, and adverse effects were recorded. Postoperative blood samples were collected daily, and flexible sigmoidoscopy was performed 8-12 weeks after surgery to examine the anastomoses.
Fourteen out of 25 patients underwent CARP. CARP was not used in 11 patients due to advanced tumor disease (two cases) and size restrictions (nine cases). No case of anastomotic leakage, bowel obstruction, or stenosis formation was observed. No device-related perioperative adverse events were noted. The surgical device evacuated spontaneously in all patients by the natural route after a median of 10 days. Perioperative compression pressure ranged between 85 and 280 mBar (median 130 mBar). Flexible sigmoidoscopy revealed smooth anastomoses without signs of pathological inflammation or stenosis in all cases.
Our results indicate that the novel suture-less CARP is a safe and effective method for creating colonic anastomoses. Further studies are warranted in larger patient populations to compare CARP head-on-head with stapled and/or hand-sewn colonic anastomoses.
压缩吻合环锁定术（CARP）是一种用于创建结肠吻合口的新方法。该手术允许在围手术期对吻合口内肠端之间的压缩压力进行量化，并在术后监测吻合口的完整性。我们最近表明，CARP是一种用于猪结肠吻合术的安全有效的方法，本研究的目的是评估CARP在人类结肠吻合术中的应用。
这是一项对25例接受择期左侧结肠切除术患者的前瞻性研究。记录吻合环排出时间、围手术期压缩压力和不良反应。每天采集术后血样，并在术后8 - 12周进行乙状结肠镜检查以检查吻合口。
25例患者中有14例接受了CARP。由于肿瘤病情进展（2例）和尺寸限制（9例），11例患者未使用CARP。未观察到吻合口漏、肠梗阻或狭窄形成的病例。未发现与器械相关的围手术期不良事件。手术器械在中位时间10天后通过自然途径在所有患者中自发排出。围手术期压缩压力范围在85至280毫巴之间（中位值130毫巴）。乙状结肠镜检查显示所有病例的吻合口均光滑，无病理炎症或狭窄迹象。
我们的结果表明，新型无缝合CARP是一种创建结肠吻合口的安全有效的方法。有必要在更大规模的患者群体中进行进一步研究，以将CARP与吻合器和/或手工缝合的结肠吻合术进行直接比较。
