RESULTS USING THE BIOFRAGMENTABLE ANASTOMOTIC RING FOR COLON ANASTOMOSIS

The Biofragmentable Anastomotic Ring (BAR) (Valtrac(TM), Davis & Geck, Inc.) is a newly approved device intended for colonic anastomosis. We have used the device in 47 patients to date. These patients were stud ied to determine the effectiveness, uses and limitations of this new d evice. The BAR is similar in concept to the older Murphy ''Button'' us ed circa World War 1, but it's constructed of polyglycolic acid rather than metal. Anastomosis is effected by placing the two bowel lumens o ver the device, tying the purse-string sutures snugly, and 'clicking'' the device closed. The BAR fragments and is passed 2 to 3 weeks posto peratively. The patients ranged from 14 to 82 years of age. Thirty-nin e patients were operated on for cancer, four for diverticulitis, and f our for colostomy closure. One transverse colectomy (THC), 15 left hem icolectomies (LHC), 23 sigmoid colectomies (SC), two low anterior rese ctions (LAR), four colostomy closures, and two right hemicolectomies w ere performed. There were no anastomotic leaks and no complications. W e found that because of the need to have access distally to ''click'' the device closed, BAR anastomosis after LAR is rarely feasible. Becau se of the small lumenal size of the distal ileum, the BAR is seldom us able for ileocolonic anastomosis after right hemicolectomy (RHC). The newly approved 25-mm BAR may change this. We found that the time requi red to perform an anastomosis with the BAR is equivalent to stapled te chniques. At our hospital, the cost of the device is equivalent to one intestinal stapler. Since multiple staplers are used in most colon an astomotic techniques, there is a modest cost advantage for the BAR. Ba sed on these results, we feel the BAR is a useful device for colonic a nastomosis after THC, LHC, and SC. It has limited usefulness for RHC a nd LAR.