Techniques in Coloproctology

, Volume 21, Issue 3, pp 177–184 | Cite as

A systematic analysis of controlled clinical trials using the NiTi CAR™ compression ring in colorectal anastomoses

  • R. Tabola
  • R. CirocchiEmail author
  • A. Fingerhut
  • A. Arezzo
  • J. Randolph
  • V. Grassi
  • G. A. Binda
  • V. D’Andrea
  • I. Abraha
  • G. Popivanov
  • S. Di Saverio
  • A. Zbar


Anastomotic leak following colorectal surgery can be a devastating adverse event. The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction which potentially contribute to early anastomotic dehiscence or late anastomotic stricture. A systematic review was performed examining available data on controlled randomized and non-randomized trials assessing the NiTi compression anastomosis ring—(NiTi CAR™) (NiTi Solutions, Netanyah Israel) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. A protocol for this meta-analysis has been registered on PROSPERO (CRD42016050934). The initial search yielded 45 potentially relevant articles. After screening titles and abstracts for relevance and assessment for eligibility, 39 of these articles were eventually excluded leaving 6 studies for analysis in the review. Regarding the primary outcome measure, the overall anastomotic leak rate was 2.2% (5/230) in the compression anastomosis group compared with 3% (10/335) in the conventional anastomosis group; this difference was not statistically significant (RR 0.75, 95% CI 0.25–2.24; participants = 565; studies = 6; I 2 = 0%). There were no statistically significant differences between compression and conventional anastomoses in any of the secondary outcomes. This review was unable to demonstrate any statistically significant differences in favor of the compression anastomosis technique over conventional manual or stapled mechanical anastomoses.


Compression anastomosis NiTi CAR ColonRing Biofragmentable anastomotic ring BAR Anastomotic leak 



Dr. Alessandro Quintili developed and performed the search strategy, protocol draft, trial selection.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Supplementary material

10151_2017_1583_MOESM1_ESM.doc (57 kb)
SDC 1 PRISMA flow diagram (DOC 57 kb)
10151_2017_1583_MOESM2_ESM.docx (13 kb)
SDC 2 Characteristics of the studies included in the analysis (DOCX 13 kb)
10151_2017_1583_MOESM3_ESM.docx (14 kb)
SDC 3 Patient demographics and clinical characteristics (DOCX 14 kb)
10151_2017_1583_MOESM4_ESM.docx (13 kb)
SDC 4 Surgical characteristics of rectum and colon resection (DOCX 13 kb)
10151_2017_1583_MOESM5_ESM.docx (13 kb)
SDC 5 Surgical characteristics of anastomosis (DOCX 13 kb)
10151_2017_1583_MOESM6_ESM.docx (14 kb)
SDC 6 Oncological characteristics (DOCX 13 kb)
10151_2017_1583_MOESM7_ESM.docx (17 kb)
SDC 7 Risk of bias graph of RCTs (DOCX 17 kb)
10151_2017_1583_MOESM8_ESM.docx (15 kb)
SDC 8 Risk of bias summary of RCTs (DOCX 15 kb)
10151_2017_1583_MOESM9_ESM.docx (13 kb)
SDC 9 Evaluation of methodological qualities of non-RCT studies (DOCX 13 kb)
10151_2017_1583_MOESM10_ESM.docx (18 kb)
SDC 10 Postoperative bleeding (DOCX 18 kb)


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • R. Tabola
    • 1
  • R. Cirocchi
    • 2
    Email author
  • A. Fingerhut
    • 3
  • A. Arezzo
    • 4
  • J. Randolph
    • 5
  • V. Grassi
    • 2
  • G. A. Binda
    • 6
  • V. D’Andrea
    • 7
  • I. Abraha
    • 8
  • G. Popivanov
    • 9
  • S. Di Saverio
    • 10
  • A. Zbar
    • 11
    • 12
  1. 1.Department of General and Gastrointestinal SurgeryMedical University of WrocławWrocławPoland
  2. 2.Department of General and Oncologic SurgeryUniversity of PerugiaPerugiaItaly
  3. 3.Section for Surgical Research, Department of SurgeryMedical University of GrazGrazAustria
  4. 4.Department of Surgical SciencesUniversity of TurinTurinItaly
  5. 5.Tift College of EducationMercer UniversityAtlantaUSA
  6. 6.Colorectal Surgery UnitGalliera HospitalGenoaItaly
  7. 7.Department of Surgical Sciences“Sapienza” University of RomeRomeItaly
  8. 8.Department of Geriatrics and Geriatric Emergency CareItalian National Research Center on Aging (IRCCS-INRCA)AnconaItaly
  9. 9.Department of Abdominal SurgeryMilitary Medical AcademySofiaBulgaria
  10. 10.General (Colorectal), Emergency and Trauma Surgery Service, Maggiore Hospital Regional Emergency Surgery and Trauma CenterBologna Local Health ServicesBolognaItaly
  11. 11.Department of Surgery and TransplantationChaim Sheba Medical CenterRamat GanIsrael
  12. 12.Department of AnatomyUniversity of OtagoDunedinNew Zealand

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