Gastrointestinal tract anastomoses with the biofragmentable anastomosis ring: is it still a valid technique for bowel anastomosis? Analysis of 203 cases and review of the literature.

PURPOSE: Biofragmentable anastomosis ring (BAR) is an alternative to manual and stapled anastomoses performed within the upper and lower gastrointestinal (GI) tract. The aim of this study was to evaluate the effectiveness of BAR utility for bowel anastomoses based on our own material. METHODS: A retrospective analysis was performed to a total of 203 patients who underwent bowel surgery with the use of BAR anastomosis within upper and lower gastrointestinal tract between 2004 and 2014. Data for the analysis was collected based on medical records, treatment protocols, and the results of histological examinations. RESULTS: The study group consisted of 86 women and 117 men. The most common underlying pathology was a malignant disease (n = 165). Biofragmentable anastomosis ring (BAR) size 31 was the most commonly used (n = 87). A total of 169 colocolic or colorectal anastomoses and 28 ileocolic and 8 enteroenteric anastomoses were performed. The mortality rate was 0.5 % (n = 1) whereas re-surgery rate within 30 days was 8.4 % (n = 17). Twenty-eight patients developed perioperative complications with surgical site infection as the most common one (n = 11). Eight patients developed specific complications associated with BAR including an anastomotic leak (n = 6) and intestinal obstruction (n = 2). The mean time of hospital stay after surgery was 12.7 days. CONCLUSIONS: The use of BAR for the GI tract anastomoses is simple and rapid method and it is characterized with an acceptable number of perioperative mortality and complication rates. Based on our experience, we recommend the use of BAR anastomosis in different types of intestinal anastomosis in varying clinical scenarios.

Status and progress of the research of preventing anastomosis leakage / 国际外科学杂志

Anastomotic leak belongs to the serious complications of low anterior resection with high morbidity and fatality.In recent decades,many strategies aimed at lowering the incidence of anastomotic leakage have been developed.This review focused on the methods for preventing anastomotic leakage through searching PudMed and Wanfang data for all related papers.Strategies were categorised as defunctioning stoma,transcecal catheter ileostomy,indwelling rectal tube,valtrac-secured intracolonic bypass technique,free take-back ileostomy.Every strategy has its own advantages and disadvantages.But to date,except defunctioning stoma,none of the methods has been widely accepted due to the lack of high level evidences.However,free take-back ileostomy can avoid stoma related complication and readmission for closure and its initial effect is good,so deserve to further research.

Sutureless Gastroduodenostomy after Radical Subtotal Gastrectomy

PURPOSE: A gastroduodenostomy (Billroth I) is the most physiologic reconstructive method available today, it has recently been used more frequently subsequent to radical subtotal gastrectomies for the treatment of gastric cancers. However, it is inevitable that gastroduodenostomies involving sutures or staples may have complications such as ulcers, bleeding, or constriction caused by remaining foreign materials. We analyzed the results of sutureless gastroduodeno stomies using biofragmentable anastomosis rings (BAR) with regard to safety, usefulness and profits. METHODS: Sutureless gastroduodenostomies using BAR (Valtrac, Davis & Geck Wayne, NJ) composed of polyglycolic acid and Barium for x-ray visualization, performed after radical subtotal gastrectomies in 17 gastric cancer patients in the period from 1999 to 2001. RESULTS: Five patients had early cancers and 12 had advanced cancers. The mean size of the tumor masses was 5.0 X 3.7 cm, and the mean lengths of the proximal and distal resection margins from the tumors were 7.6 cm and 3.0 cm respectively. The lengths of lesser curvature and greater curvature of the resection specimens were 10.6 cm and 20.5 cm respectively. Fourteen tumors were located in the antrum and the other 3 were located in the body. The mean operating time was 164.4+/-35.2 min., and the mean hospital stay was 14.1+/-3.1 days. Sips of water could be started 4.4+/-0.5 days after the operation. In all patients, the sutureless gastroduodenostomy site appeared watertight and maintained its initial burst strength, which was verified using gastrografin x-ray visualization performed 1 week after the operation. There were no anastomosis related complications in any of the patients; except for two mild satiety, which were treated quickly by the patients themselves. The BAR began to fragment 3 weeks after the operation, and disappeared completely within 4 weeks. The diameters of the anastomosis sites were large enough to pass foods without constriction and no other secondary changes developed in the Barium x-ray visualization or endoscopic examination, which was performed 1 month after the operation. CONCLUSION: A sutureless gastroduodenostomy using BAR is a safe, easy, and efficient reconstructive method to be used subsequent to a radical subtotal gastrectomy for gastric cancers.

Sutureless Gastroduodenostomy

A gastroduodenostomy is the most physiological reconstruction after a distal gastrectomy. However, a gastroduodenostomy with either sutures or staples has many complications. These include bleeding, leakage and stenosis. A sutureless gastroduodenostomy with a biofragmentable anastomosis ring (BAR) in was used adenocarcinoma patients to prevent these complications from 1999. A BAR is composed of polyglycolic acid and Barium sulfate to allow for X-ray visualization. Hardy in first introduced the BAR in 1985. Since then, it has been used in an anastomosis of the colon or small bowel surgery but its use in a gastroduodenostomy is the first trial in the world. A 70 year male patient, old who received a subtotal gastrectomy (Billroth I), underwent a A sutureless gastroduodenostomy with a BAR. The gastroduodenostomy with the BAR was watertight and maintained the initial burst strength in the gastrografin X-ray study performed at the postoperative 1 week. The BAR began to fragment 3 weeks after the operation and disappeared from the digestive tract completely. The diameter of the anastomosis site was sufficient for passed foods. No other secondary changes from remained foreign bodies were found in the endoscopic examination. In a second operation to treat a primary hepatoma, there was no adhesive changes around the gastroduodenostomy site. In conclusion, a sutureless gastroduodenostomy with BAR is a safe, easy and efficient reconstructive method after a distal gastrectomy.

A randomized controlled study on the application of the biofragmentable anastomosis ring and manual suture in intestinal anastomosis / 中国普通外科杂志

0.05).Anastomotic inflammatory reaction occurred in 2 patients(3.2%) in BAR group and 13 patients(20.0%) in manual group.The difference was statistically significant(P

Comparison of Sutureless Anastomosis Using the ValtracTM Biofragmentable Anastomosis Ring with Conventional Manual Suture Anastomosis in Enterocolic Surgery

No abstract available.