THE BIOFRAGMENTABLE RING IN INTESTINAL SURGERY

The Biofragmentable Anastomosis Ring (BAR) is a device, which original ly has been designed for sutureless large bowel anastomoses. In this s tudy, the method is evaluated in comparison with sutured and stapled a nastomoses through experimental surgery. Clinical results of colonic B AR anastomoses are compared to those gained by sutured anastomoses. Ne w applications of the anastomosis ring: small bowel anastomoses and ch olecystojejunostomies are introduced in clinical trials. Fourteen dogs had a laparotomy with three consequent colonic transections. These we re 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 animal s were sacrificed, and each operated colonic segment was removed for e xamination. In four animals dilatation 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 inflamme d mucosa was observed with the BAR, and the least reaction was connect ed to the stapled anastomoses. Forty days after the operation all the three types of anastomoses had healed equally well both macroscopicall y and histologically. One hundred and fifty patients undergoing coloni c surgery were randomized into two groups: 71 underwent hand-suture an d 79 were fitted with the BAR. Five patients, two treated using the BA R and three by suturing, developed anastomotic leakage. During follow up, one patient in each group underwent reoperation for anastomotic st ricture. Recovery of the gastrointestinal tract and the hospital stay were similar in the two groups. The late results after colonic anastom oses performed with the BAR were evaluated in 26 patients who had unde rgone a left sided colonic or rectosigmoid anastomosis. One had been o perated on for an anastomotic stricture 22 months after the initial op eration, which was a sigmoid resection. One had been operated during t he study for reasons not related to the anastomosis. 24 patients under went the study scheme. In 16 of the patients, the anastomosis could no t be radiologically identified, and in seven not even during endoscopy . Histologically there was mild to moderate fibrosis and scarring in 1 7 anastomoses and in the seven that could not be identified, only norm al colonic mucosa was found. Of one hundred and seventy patients under going upper gastrointestinal surgery, 81 had the jejunojejunal enteroa nastomosis done with the BAR and 89 patients received sutures. Both en d - to - side (101 patients) and side - to - side reconstructions (69 patients) were done. Neither ruptures nor obstructions of the enteroan astomosis occurred. The postoperative recovery of the gastrointestinal tract and duration of hospital stay were similar in the two groups. A cholecystojejunostomy for the relief of obstructive icterus was perfo rmed in twenty patients, in ten with the BAR and in ten by suturing. S urgical complications did not occur in either group. The relief of ict erus, recovery of the gastrointestinal tract and the hospital stay wer e similar in both groups. The biofragmentable ring proves a reliable m ethod for the construction of colonic anastomoses, with good immediate and long - term results. The device is also proved suitable for anast omoses of the small bowel as well as the cholecystoenterostomies. An e valuation of the costs and benefits of the various methods was not per formed in this investigation. This aspect still remains to be studied before estimating the final standing of the device among the establish ed methods for the intestinal anastomosis.