OVERVIEW ON COMPRESSION ANASTOMOSES - BIOFRAGMENTABLE ANASTOMOSIS RING MULTICENTER PROSPECTIVE TRIAL OF 1666 ANASTOMOSES

This study represents a European prospective clinical multicenter tria l and was undertaken to evaluate the applicability of the biofragmenta ble anastomosis ring (BAR) as a routine anastomotic tool in teaching h ospitals, The trial results analyzed consisted of 1666 BAR anastomoses performed in 1360 patients from March 1989 to May 1996 in the upper ( 1042 anastomoses) and lower (624 anastomoses) gastrointestinal (GI) tr act, Only patients selected for elective procedures and having previou sly undergone orthograde bowel cleansing were entered into the trial, In the upper GI tract six anastomoses (0.58%) developed clinically rel evant and radiologically detectable leaks with indications for reopera tion. In the lower GI tract 42 (6.73%) anastomoses shelved a radiologi cally detectable leak with clinical manifestations in 28 cases (4.48%) . Reoperation was performed in 18 cases (2.80%). The overall leakage r ate with clinical relevance was 2.04%. Three gastrojejunostomy episode s of bleeding were observed (0.18%) at the BAR anastomotic site, Durin g the early postoperative course there was no ileus due to obstruction of a BAR anastomosis. Reintroduction of diet after the operation was not delayed, In two centers a follow-up evaluation reported no BAR-rel ated late anastomotic stenoses. There were no intraoperative deaths, b ut 54 patients died postoperatively. Peritonitis following anastomotic leakage was responsible for postoperative deaths in four cases; three of them were related to BAR anastomoses, In conclusion, the BAR anast omotic procedure is an established, rapid, simple to learn, highly sta ndardized, safe technique with the advantage of no persistent foreign material in the anastomotic region and therefore no induction of steno sis. At present, the application of anastomoses in various segments of the GI tract, from the stomach to the middle third of the rectum, can be recommended.