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Compression anastomotic ring-locking procedure (CARP) is a safe and effective method for intestinal anastomoses following left-sided colonic resection

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Compression anastomotic ring-locking procedure (CARP) is a novel procedure for creating colonic anastomoses. The surgical procedure allows perioperative quantification of the compression pressure between the intestinal ends within the anastomosis and postoperative monitoring of the anastomotic integrity. We have recently shown that CARP is a safe and effective method for colonic anastomoses in pigs, and the purpose of the present study was to evaluate CARP for colonic anastomoses in humans.

Materials and methods

This is a prospective study on 25 patients undergoing elective left-sided colonic resection. Time for evacuation of the anastomotic rings, perioperative compression pressure, and adverse effects were recorded. Postoperative blood samples were collected daily, and flexible sigmoidoscopy was performed 8–12 weeks after surgery to examine the anastomoses.

Results

Fourteen out of 25 patients underwent CARP. CARP was not used in 11 patients due to advanced tumor disease (two cases) and size restrictions (nine cases). No case of anastomotic leakage, bowel obstruction, or stenosis formation was observed. No device-related perioperative adverse events were noted. The surgical device evacuated spontaneously in all patients by the natural route after a median of 10 days. Perioperative compression pressure ranged between 85 and 280 mBar (median 130 mBar). Flexible sigmoidoscopy revealed smooth anastomoses without signs of pathological inflammation or stenosis in all cases.

Conclusion

Our results indicate that the novel suture-less CARP is a safe and effective method for creating colonic anastomoses. Further studies are warranted in larger patient populations to compare CARP head-on-head with stapled and/or hand-sewn colonic anastomoses.

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Acknowledgments

This work was supported by grants from the Swedish Medical Research Council (2012-3685), Crafoordska stiftelsen, Einar och Inga Nilssons stiftelse, Harald och Greta Jaenssons stiftelse, Greta och Johan Kocks stiftelser, Fröken Agnes Nilssons stiftelse, Franke och Margareta Bergqvists stiftelse för främjande av cancerforskning, Magnus Bergvalls stiftelse, Mossfelts stiftelse, Nanna Svartz stiftelse, Ruth och Richard Julins stiftelse, Svenska Läkaresällskapet, Allmänna sjukhusets i Malmö stiftelse för bekämpande av cancer, MAS fonder, Malmö University Hospital, and Lund University.

Conflict of interest

AG and HT are co-inventors of CARP, and both hold shares in CarpoNovum AB.

Author information

Authors and Affiliations

  1. Department of Clinical Sciences, Section of Surgery, Lund University, 205 02, Malmö, Sweden

    Dadi Vilhjalmsson, Stefan Appelros, Ingvar Syk & Henrik Thorlacius

  2. Department of Clinical Sciences, Section of Gastroenterology, Lund University, 205 02, Malmö, Sweden

    Ervin Toth

  3. Section of Development, CarpoNovum, 302 41, Halmstad, Sweden

    Anders Grönberg

  4. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark

    Tommie Mynster

Authors
  1. Dadi Vilhjalmsson
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  2. Stefan Appelros
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  3. Ervin Toth
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  4. Ingvar Syk
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  5. Anders Grönberg
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  6. Tommie Mynster
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  7. Henrik Thorlacius
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Correspondence to Henrik Thorlacius.

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Vilhjalmsson, D., Appelros, S., Toth, E. et al. Compression anastomotic ring-locking procedure (CARP) is a safe and effective method for intestinal anastomoses following left-sided colonic resection. Int J Colorectal Dis 30, 969–975 (2015). https://doi.org/10.1007/s00384-015-2257-z

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  • DOI: https://doi.org/10.1007/s00384-015-2257-z

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