The biofragmentable ring in intestinal surgery.

The Biofragmentable Anastomosis Ring (BAR) is a device, which originally has been designed for sutureless large bowel anastomoses. In this study, the method is evaluated in comparison with sutured and stapled anastomoses through experimental surgery. Clinical results of colonic BAR anastomoses are compared to those gained by sutured anastomoses. New applications of the anastomosis ring: small bowel anastomoses and cholecystojejunostomies are introduced in clinical trials. Fourteen dogs had a laparotomy with three consequent colonic transections. These were anastomosed; one by manual suture, one with a circular stapler and one with the BAR. On day 1, 3, 5, 7, or 40, postoperatively, the animals were sacrificed, and each operated colonic segment was removed for examination. In four animals dilation of the bowel was seen proximal to the BAR anastomosis. No clinical obstruction had been noted in them, however. Up to the seventh postoperative day, edematous and inflamed mucosa was observed with the BAR, and the least reaction was connected to the stapled anastomoses. Forty days after the operation all the three types of anastomoses had healed equally well both macroscopically and histologically. One hundred and fifty patients undergoing colonic surgery were randomized into two groups: 71 underwent hand-suture and 79 were fitted with the BAR. Five patients, two treated using the BAR and three by suturing, developed anastomotic leakage. During follow up, one patient in each group underwent reoperation for anastomotic stricture. Recovery of the gastrointestinal tract and the hospital stay were similar in the two groups. The late results after colonic anastomoses performed with the BAR were evaluated in 26 patients who had undergone a left sided colonic or rectosigmoid anastomosis. One had been operated on for an anastomotic stricture 22 months after the initial operation, which was a sigmoid resection. One had been operated during the study for reasons not related to the anastomosis. 24 patients underwent the study scheme. In 16 of the patients, the anastomosis could not be radiologically identified, and in seven not even during endoscopy. Histologically there was mild to moderate fibrosis and scarring in 17 anastomoses and in the seven that could not be identified, only normal colonic mucosa was found. Of one hundred and seventy patients undergoing upper gastrointestinal surgery, 81 had the jejunojejunal enteroanastomosis done with the BAR and 89 patients received sutures. Both end-to-side (101 patients) and side-to-side reconstructions (69 patients) were done. Neither ruptures nor obstructions of the enteroanastomosis occurred.(ABSTRACT TRUNCATED AT 400 WORDS)