Skip to main content
SpringerLink
Log in

Compression anastomoses in colon and rectal surgery with the NiTi ColonRing™

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

The aim of this prospective study was to evaluate safety and efficacy of the NiTi ColonRing™ for anastomoses on the colon or rectum.

Methods

During the period September 2008–June 2011, anastomosis using the NiTi ColonRing™ was scheduled to be performed on 60 patients (36 females, 24 males/mean aged 67 years), 53 of whom underwent colectomy for cancer and 7 reconstruction after Hartmann’s procedure. Application of the device failed in one case due to anatomical reasons. Colorectal resections performed were as follows: Right hemicolectomy (5 patients), left colectomy (2), sigmoidectomy (15) and low anterior resection (31). A follow-up clinic visit after 1 month was planned for all patients. Ten patients among the first 14 had rectosigmoidoscopy at 2–3 months. All cancer patients were scheduled for colonoscopy at 12 months.

Results

No intraoperative or postoperative bleeding related to the anastomotic technique was recorded. Median hospital stay after surgery was 10.2 days (9–22 days). One patient died on day 13 due to myocardial infarction. Clinically apparent leak was detected in one patient who had undergone reconstruction after Hartmann; the only treatment required was total parenteral nutrition for 12 days. Anastomotic stenosis occurred in another one patient who had undergone reconstruction after Hartmann; it was easily resolved by balloon dilatation. Mild complications were encountered in 23 other patients (39%). Oral feeding started after day 4. Anastomotic rings were expelled naturally within 7–17 days (mean, 9.2 days). A satisfactory anastomosis was revealed in patients examined colonoscopically at 2–3 and 12 months. Mean follow-up was 15.2 months (2–33 months).

Conclusions

NiTi ColonRing™ is reliable, safe and efficacious for large bowel anastomoses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wullstein C, Gross E (2000) Compression anastomosis (AKA-2) in colorectal surgery: results in 442 consecutive patients. Br J Surg 87:1071–1075

    Article  PubMed  CAS  Google Scholar 

  2. Aggarwal R, Darzi A (2005) Compression anastomosis revisited. J Am Coll Surg 201:965–971

    Article  PubMed  Google Scholar 

  3. Kopelman D, Lelcuk S, Sayfan J et al (2007) End-to-end compression anastomosis of the rectum: a pig model. World J Surg 31:532–537

    Article  PubMed  Google Scholar 

  4. D’Hoore A, Hompes D, Folkesson J, Penninckx F, Pählman L (2008) Circular “superelastic” compression anastomosis: from the animal lab to clinical practice. Minim Invasive Ther Allied Technol 17:172–175

    Article  PubMed  Google Scholar 

  5. Kaidar-Person O, Rosenthal RJ, Wexner SD, Szomstein S, Person B (2008) Compression anastomosis: history and clinical considerations. Am J Surg 195:827–838

    Article  Google Scholar 

  6. Buchberg BS, Masoomi H, Bergman H, Mills SD, Stamos MJ (2011) The use of a compression device as an alternative to hand-sewn and stapled colorectal anastomoses: is three a crowd? J Gastrointest Surg 15:304–310

    Article  PubMed  Google Scholar 

  7. Steichen FM, Ravitch MM (1984) History of mechanical devices and instruments for suturing. In: Stapling in surgery. Year Book Medical Publishers, Chicago, pp 3–78

  8. Fingerhut A, Elhadad A, Hay JM, Lacaine F, Flamant Y (1994) Infraperitoneal colorectal anastomosis: hand-sewn versus circular staples. A controlled clinical trial. French Associations for Surgical Research. Surgery 116:484–490

    PubMed  CAS  Google Scholar 

  9. Katz S, Izhar M, Mirelman D (1981) Bacterial adherence to surgical sutures. A possible factor in suture induced infection. Ann Surg 194:35–41

    Article  PubMed  CAS  Google Scholar 

  10. Bokey EL, Chapuis PH, Fung C et al (1995) Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 38:480–487

    Article  PubMed  CAS  Google Scholar 

  11. Reinbach D, McGregor JR, O’Dwyer PJ (1993) Effect of suture material on tumour cell adherence at sites of colonic injury. Br J Surg 80:774–776

    Article  PubMed  CAS  Google Scholar 

  12. Fingerhut A, Hay JM, Elhadad A, Lacaine F, Flamant Y (1995) Supraperitoneal colorectal anastomosis: hand-sewn versus circular staples—a controlled clinical trial. French associations for surgical research. Surgery 118:479–485

    Article  PubMed  CAS  Google Scholar 

  13. Hardy TG Jr, Pace WG, Maney JW, Katz AR, Kaganov AL (1985) A biofragmentable ring for sutureless bowel anastomosis. An experimental study. Dis Colon Rectum 28:484–490

    Article  PubMed  Google Scholar 

  14. Hardy KJ (1990) Non-suture anastomosis: the historical development. Aust N Z J Surg 60:625–633

    Article  PubMed  CAS  Google Scholar 

  15. McCue JL, Philips RK (1991) Sutureless intestinal anastomoses. Br J Surg 78:1291–1296

    Article  PubMed  CAS  Google Scholar 

  16. Chua CL (1993) Colonic anastomosis with sutureless biofragmentable rings. Singap Med J 34:541–544

    CAS  Google Scholar 

  17. Nudelman IL, Fuko W, Morgenstern S, Giler SH, Lelcuk SH (2000) Gastrointestinal anastomosis with the nickel-titanium double ring. World J Surg 24:874–877

    Article  PubMed  CAS  Google Scholar 

  18. Nudelman IL, Nudelman I, Fuko V, Rubin M, Lelcuk S (2004) A nickel-titanium memory-shaped device for colonic anastomosis in laparoscopic surgery. Surg Endosc 18:1085–1089

    Article  PubMed  CAS  Google Scholar 

  19. Nudelman I, Fuko V, Waserberg N et al (2005) Colonic anastomosis performed with a memory shaped device. Am J Surg 190:434–438

    Article  PubMed  Google Scholar 

  20. Stewart D, Hunt S, Pierce R et al (2007) Validation of the NITI endoluminal compression anastomosis ring (EndoCAR) device and comparison to the traditional circular stapled colorectal anastomosis in a porcine model. Surg Innov 14:252–260

    PubMed  Google Scholar 

  21. Kopelman D, Hatoum OA, Kimmel B et al (2007) Compression gastrointestinal anastomosis. Expert Rev Med Devices 4:821–828

    Article  PubMed  Google Scholar 

  22. Szold A (2008) New concepts for a compression anastomosis: superelastic clips and rings. Minim Invasive Ther Allied Technol 17:168–171

    Article  PubMed  Google Scholar 

  23. Tucker ON, Beglaipter N, Rosenthal RJ (2008) Compression anastomosis for Roux-en-Y gastric bypass: observations in a large animal model. Surg Obes Relat Dis 4:115–121

    Article  PubMed  CAS  Google Scholar 

  24. Liu PC, Jiang ZW, Zhu XL et al (2008) Compression anastomosis clip for gastrointestinal anastomosis. World J Gastroenterol 14:4938–4942

    Article  PubMed  Google Scholar 

  25. Dauser B, Herbst F (2009) NITI endoluminal compression anastomosis ring (NITI CAR 27®): a breakthrough in compression anastomoses? Eur Surg 41:116–119

    Article  Google Scholar 

  26. Jansen A, Brummelkamp WH, Davies GA et al (1981) Clinical applications of magnetic rings in colorectal anastomosis. Surg Gynecol Obstet 153:537–545

    PubMed  CAS  Google Scholar 

  27. Kanshin NN, Lytkin MI, Knysh VI, Klur Vlu, Khamidov AI (1984) First experience with application of compression anastomoses with the apparatus AKA-2 in operations on the large intestine. Vestn Khir Im II Grek 132:52–57 (Russian)

    CAS  Google Scholar 

  28. Senagore A, Milsom JW, Walshaw RK, Dunstan R, Chaudry ICH (1992) Does a proximal colectomy affect colorectal anastomotic healing? Dis Colon Rectum 35:182–188

    Article  PubMed  CAS  Google Scholar 

  29. Akyol AM, McGregor JR, Galloway DJ, Murray G, George WD (1991) Recurrence of colorectal cancer after sutured and stapled large bowel anastomosis. Br J Surg 78:1297–1300

    Article  PubMed  CAS  Google Scholar 

  30. Kopelman D (2007) Compression anastomosis, the optimal hollow viscus anastomosis: are we there yet? Expert Rev Med Devices 4:423–425

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that no conflict of interest exists.

Author information

Authors and Affiliations

  1. 2nd Department of Surgery, General Hospital of N. Ionia “Constantopoulion—Aghia Olga”, Athens, Greece

    C. Avgoustou, P. Penlidis, A. Tsakpini, C. Sioros & D. Giannousis

  2. Hellenic National Health System, Ploutarchou 13, Gerakas Attikis, 15344, Athens, Greece

    C. Avgoustou

Authors
  1. C. Avgoustou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Penlidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Tsakpini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Sioros
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Giannousis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Avgoustou.

Additional information

This article is partially based on the oral presentation given at the 27th Panhellenic Congress of Surgery—International Surgical Forum 2010 (Athens, 24–27 November 2010).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Avgoustou, C., Penlidis, P., Tsakpini, A. et al. Compression anastomoses in colon and rectal surgery with the NiTi ColonRing™. Tech Coloproctol 16, 29–35 (2012). https://doi.org/10.1007/s10151-011-0794-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-011-0794-1

Keywords

Search

Navigation