title: End-to-end compression anastomosis of the rectum: a pig model.
abstract: BACKGROUND
  Generations of investigators have attempted to achieve compression bowel anastomosis by a sutureless device, providing temporary support to the tissue and facilitating the natural healing process. The biocompatibility of nickel-titanium alloy has made it attractive for use in medical implants and devices, and several studies have described the creation of a side-to-side compression anastomosis in colon surgery with a nickel-titanium clip. We evaluated the feasibility and safety of a newly designed gun for applying a nickel-titanium compression anastomosis ring (CAR) to create an end-to-end colorectal anastomosis in a porcine model.
  
  
  METHODS
  A segment of the proximal rectum was resected in 25 pigs. The bowel ends were anastomosed transanally by an end-to-end CAR device. The animals' follow-up continued for up to 8 weeks, and included general health status, weight gain, blood tests, and abdominal X-ray. They were then sacrificed. The anastomoses were studied for burst pressure, anastomotic index, and histopathology.
  
  
  RESULTS
  One pig died due to iatrogenic bowel injury unrelated to the CAR device. There was no other morbidity/mortality. The other animals recovered and gained weight. Burst pressure studies demonstrated a minimum pressure of 160 mmHg at time point 0 that escalated quickly to >300 mmHg. The mean anastomotic index after 8 weeks was 0.81. Histologic evaluation revealed minimal inflammation and minimal fibrosis at the anastomosis site.
  
  
  CONCLUSIONS
  The principles of compression anastomosis are better executed with the use of memory shape alloys. The promising results of this novel technique should encourage further studies of this technology.
authors.affiliation: Department of Surgery B, HaEmek Medical Center, Afula, Israel. Kopelman_d@clalit.org.il
authors.forename: Doron
authors.initials: D
authors.lastname: Kopelman
authors.forename: Shlomo
authors.initials: S
authors.lastname: Lelcuk
authors.forename: Joel
authors.initials: J
authors.lastname: Sayfan
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Matter
authors.forename: Ehud P
authors.initials: EP
authors.lastname: Willenz
authors.forename: Luis
authors.initials: L
authors.lastname: Zaidenstein
authors.forename: Ossama A
authors.initials: OA
authors.lastname: Hatoum
authors.forename: Boaz
authors.initials: B
authors.lastname: Kimmel
authors.forename: Amir
authors.initials: A
authors.lastname: Szold
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D000818:Animals; D001672:Biocompatible Materials; D005240:Feasibility Studies; D005260:Female; D009532:Nickel; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D012007:Rectum / Q000601:surgery*; D013552:Swine; D014025:Titanium
chemical_list: D001672:Biocompatible Materials; D009532:Nickel; D014025:Titanium