RANDOMIZED TRIAL OF A BIOFRAGMENTABLE BOWEL ANASTOMOSIS RING IN HIGH-RISK COLONIC RESECTION

Background Biofragmentable anastomosis ring (BAR) has been proven to b e a safe anastomotic device in elective surgery. The use of this anast omotic ring in high-risk patients has not been established. Methods Du ring a 5-year period (1990-1995), 100 high-risk patients undergoing co lonic resection and suitable for a primary anastomosis were allocated randomly to a standard suture technique or to anastomosis performed wi th a BAR. High risk was defined as large bowel obstruction, complicate d diverticular disease, Crohn's disease, local cancer recurrence, prev iously irradiated colon, and trauma to the colon or rectum. The patien ts were equally distributed to the two groups regarding sex, age, emer gency surgery and concomitant diseases. Results In three patients allo tted to the BAR group, the device could not be used. There were three (6 per cent) postoperative deaths in each group; none was related to a nastomotic problems. Three anastomotic dehiscences were diagnosed, two (4 per cent) in the BAR group and one (2 per cent) in the suture grou p. Postoperative complications and postoperative recovery were similar . Conclusion This study shows that the BAR anastomosis probably is as safe as the standard hand-sewn anastomosis in high-risk colorectal sur gery. As the cost of a BAR anastomosis is substantially higher than th at for a hand-sewn anastomosis, the latter technique is still the pref erred method in the authors' unit.