Randomized trial of a biofragmentable bowel anastomosis ring in high-risk colonic resection.
BACKGROUND
Biofragmentable anastomosis ring (BAR) has been proven to be a safe anastomotic device in elective surgery. The use of this anastomotic ring in high-risk patients has not been established.


METHODS
During a 5-year period (1990-1995), 100 high-risk patients undergoing colonic resection and suitable for a primary anastomosis were allocated randomly to a standard suture technique or to anastomosis performed with a BAR. High risk was defined as large bowel obstruction, complicated diverticular disease, Crohn's disease, local cancer recurrence, previously irradiated colon, and trauma to the colon or rectum. The patients were equally distributed to the two groups regarding sex, age, emergency surgery and concomitant diseases.


RESULTS
In three patients allotted to the BAR group, the device could not be used. There were three (6 per cent) postoperative deaths in each group; none was related to anastomotic problems. Three anastomotic dehiscences were diagnosed, two (4 per cent) in the BAR group and one (2 per cent) in the suture group. Postoperative complications and postoperative recovery were similar.


CONCLUSIONS
This study shows that the BAR anastomosis probably is as safe as the standard band-sewn anastomosis in high-risk colorectal surgery. As the cost of a BAR anastomosis is substantially higher than that for a hand-sewn anastomosis, the latter technique is still the preferred method in the authors' unit.
Påhlman
L
L
Colorectal Unit, Uppsala University, Sweden.
Ejerblad
S
S
Graf
W
W
Kader
F
F
Kressner
U
U
Lindmark
G
G
Raab
Y
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D001466:Barium Sulfate / Q000627:therapeutic use*; D001672:Biocompatible Materials / Q000627:therapeutic use*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011100:Polyglycolic Acid / Q000627:therapeutic use*; D012086:Reoperation; D016896:Treatment Outcome
D001672:Biocompatible Materials; D001466:Barium Sulfate; D011100:Polyglycolic Acid