ENTERAL ANASTOMOSES USING THE BİOFRAGMENTABLE VALTRAC RİNG: A PROSPECTIVE STUDY

Abstract

Biofragmentable anastomotic rings (BAR) anastomoses are a new fascinating concept in gastrointestinal surgery. The aim of the following prospective study is to test its practicability and safety under the conditions of a training hospital.

From 3/1989 to 12/1991, 304 BAR anastomoses were performed in 267 patients (29 patients had 2 anastomoses; in 4 patients 3 BAR anastomoses were performed). 119 patients were operated on f or benign disease, 148 for malignant disease. We performed 155 colocolostomies (all end/end), 50 jejunocolostomies (48 end/end, 2 side/side), 75 anastomoses of the small intestine (36 end/end, 35 end/side, 4 side/side), 14 gastrojejunostomies (6 end/end, 5 end/side, 3 side/side) and 10 miscellaneous anastomoses of various types.

6.5% of the anastomoses developed radiologically detectable leakages, in 3.2% these leakages were clinically relevant. The rate of leakages was highest in the colocostomies with 10.3% radiologically, in 4.5% clinically, followed by small bowel to colon anastomoses with 4% and 2% respectively. Small bowel to small bowel anastomoses was insufficient radiologically and clinically in 1 out of 75 cases (1.3%). In the gastrojejunostomies 1 out of 14 anastomoses was insufficient. No bleeding occurred due to a BAR anastomoses. No clinically relevant stenosis was observed. There were 2 instances of subileus which healed spontaneously. The first bowel movement started after 4 days (mean). Tea was given on day 3 (range 1-8), resorbable diet at day 6 (1-14), diet at day 8 (5-18), and normal food at day 10. Enters/anastomoses with the BAR ring can be recommended as a simple to learn technique using one principle for the 3 standart techniques: End/end, end/side and side/side. The rate of leakages is comparable to those for clip suture or manual suture anastomoses at corresponding localizations. Stenoses or postoperative bleeding practically do not occur. In the colon, in the upper and middle region of the rectum as well as in the small bowel, compression anastomoses function excellently and offer an attractive alternative to manual or clip sutures.