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Experience with the biofragmentable anastomotic ring (BAR) in bowel preoperatively irradiated with 6000 rad

  • Original Contributions
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Diseases of the Colon & Rectum

Abstract

Previous studies from the authors' laboratory using the biodegradable anastomotic ring (BAR) have demonstrated the safety of this device in animals irradiated preoperatively with the equivalent of 5000 rad; sutured, stapled, and BAR anastomoses all had leak rates of 10 percent or less in this setting. This study was undertaken to assess the safety of the BAR after irradiation with the equivalent of 6000 rad. Thirteen mongrel dogs underwent preoperative irradiation to the rectum and rectosigmoid, receiving 6000 rad according to the nominal standard dose equation. After a three-week rest period, each dog underwent anterior resection of the rectosigmoid and anastomosis with the BAR. The anastomoses were evaluated for early and late healing and anastomotic leaks. The results were compared with previous data from the authors' laboratory using an identical model. Radiographic leaks were found in 7 of 10 sutured anastomoses, 8 of 10 stapled anastomoses, and 3 of 13 BAR anastomoses (P < 0.01). Comparative clinical leaks were 5 of 10 for sutured, 5 of 10 for stapled, and 3 of 13 for BAR anastomoses. These data suggest that the BAR may offer added safety to an anastomosis after preoperative irradiation. Whether this effect is due to the atraumatic technique of placing the device, improved blood flow to the anastomotic margins, or other factors, is still undetermined.

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Authors and Affiliations

  1. Department of Surgery, Hennepin County Medical Center, 701 Park Ave. So., 55415, Minneapolis, Minnesota

    J. Kevin Croston M.D., Donald M. Jacobs M.D., Peter H. Kelly M.D., Daniel A. Feeney D.V.M., Gary R. Johnston D.V.M., Robert L. Strom M.D. &  Melvin P. Bubrick M.D. (Chief)

  2. Department of Pathology, Hennepin County Medical Center, USA

    J. Kevin Croston M.D., Donald M. Jacobs M.D., Peter H. Kelly M.D., Daniel A. Feeney D.V.M., Gary R. Johnston D.V.M., Robert L. Strom M.D. &  Melvin P. Bubrick M.D. (Chief)

  3. Department of Small Animal Clinical Sciences, University of Minnesota, Minneapolis, Minnesota

    J. Kevin Croston M.D., Donald M. Jacobs M.D., Peter H. Kelly M.D., Daniel A. Feeney D.V.M., Gary R. Johnston D.V.M., Robert L. Strom M.D. &  Melvin P. Bubrick M.D. (Chief)

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  1. J. Kevin Croston M.D.
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  6. Robert L. Strom M.D.
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Croston, J.K., Jacobs, D.M., Kelly, P.H. et al. Experience with the biofragmentable anastomotic ring (BAR) in bowel preoperatively irradiated with 6000 rad. Dis Colon Rectum 33, 222–226 (1990). https://doi.org/10.1007/BF02134184

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