Colonic anastomosis performed with a memory-shaped device.

BACKGROUND: The present study was prompted by our previous successful experience with the compression anastomosis clip (CAC) on animals followed by a study on 20 patients scheduled for colonic resection. METHODS: Sixty patients with colonic cancer were assigned randomly to undergo an anastomosis either with the CAC or a stapler. To perform anastomosis with CAC, the 2 edges of the resected colon are aligned. Two 5-mm incisions are made close to the edges, through which (using a special applier) the CAC, after being cooled in ice water, is introduced in an open position. In response to the body temperature, the clip resumes its original (closed) position, thereby clamping the 2 bowel segments together. At the same time, a small scalpel incorporated in the applier makes a small incision through the clamped walls for the passage of gas and feces. The clip is detached from the applier to be left inside the intestine. The 2 5-mm incisions are sutured. The clip is expelled with the stool within 5 to 7 days, creating a perfect uniform compression anastomosis. RESULTS: Neither group had anastomotic complications such as leakage or obstruction. All the other parameters were better in the study group than in the control patients. CONCLUSIONS: The use of the CAC for colonic surgery is safe, simple, efficient, shortens operation time, and is almost what we call the "no-touch concept" in surgery and may decrease infection.

Treatment of rectal cancer by chemoradiation followed by surgery: analysis and early clinical outcome in 66 patients.

BACKGROUND: Abdominoperineal resection entails the need for a permanent colostomy, which significantly reduces patient self-image and quality of life. OBJECTIVE: To investigate the effectiveness of preoperative chemoradiation in increasing the resectability rates of rectal cancer and increasing the anal sphincter preservation rate. METHODS: The study group included 66 patients aged 33-84 years with T2-T3 rectal carcinoma who were treated in our institute from 1997 to 2002 with preoperative chemoradiation followed by surgery 6 weeks later. All patients underwent preoperative transrectal endoscopic ultrasound for tumor staging and localization. The duration of follow-up was 25 months. RESULTS: Chemoradiation led to tumor downstaging in 61 patients (92.4%), all of whom underwent low anterior resection. Only 11.4% of this group needed a temporary (6 weeks) loop colostomy/ileostomy. None of the 16 patients with post-treatment T0 tumors had evidence of malignant cells on pathologic study. Five patients (7.6%) failed to respond to chemoradiation and underwent APR. There were no major complications, such as leakage, and no deaths. CONCLUSIONS: Neoadjuvant chemoradiation is an effective modality to downstage advanced rectal cancer, improving patient quality of life by significantly reducing the need for a terminal permanent colostomy, or even a temporary one.

Colonic anastomosis with the nickel-titanium temperature-dependent memory-shape device.

BACKGROUND: This study was prompted by our successful experience with a compression anastomosis clip (CAC) in an animal model. METHODS: The study sample included 20 patients scheduled for colonic resections, of whom 10 underwent anastomosis with the CAC and 10 with staplers. RESULTS: Neither group had anastomotic or other complications, except for 1 patient in the CAC group in whom a subphrenic infected hematoma developed after left hemicolectomy with splenectomy. CONCLUSIONS: Our study demonstrates that this CAC is safe and simple to use, coming close to the "no touch surgery concept" and is of low cost compared with the staples used today.