L. Pahlman et al., RANDOMIZED TRIAL OF A BIOFRAGMENTABLE BOWEL ANASTOMOSIS RING IN HIGH-RISK COLONIC RESECTION, British Journal of Surgery, 84(9), 1997, pp. 1291-1294
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.