title: Compression anastomotic ring-locking procedure (CARP) is a safe and effective method for intestinal anastomoses following left-sided colonic resection.
abstract: BACKGROUND
  Compression anastomotic ring-locking procedure (CARP) is a novel procedure for creating colonic anastomoses. The surgical procedure allows perioperative quantification of the compression pressure between the intestinal ends within the anastomosis and postoperative monitoring of the anastomotic integrity. We have recently shown that CARP is a safe and effective method for colonic anastomoses in pigs, and the purpose of the present study was to evaluate CARP for colonic anastomoses in humans.
  
  
  METHODS
  This is a prospective study on 25 patients undergoing elective left-sided colonic resection. Time for evacuation of the anastomotic rings, perioperative compression pressure, and adverse effects were recorded. Postoperative blood samples were collected daily, and flexible sigmoidoscopy was performed 8-12 weeks after surgery to examine the anastomoses.
  
  
  RESULTS
  Fourteen out of 25 patients underwent CARP. CARP was not used in 11 patients due to advanced tumor disease (two cases) and size restrictions (nine cases). No case of anastomotic leakage, bowel obstruction, or stenosis formation was observed. No device-related perioperative adverse events were noted. The surgical device evacuated spontaneously in all patients by the natural route after a median of 10 days. Perioperative compression pressure ranged between 85 and 280 mBar (median 130 mBar). Flexible sigmoidoscopy revealed smooth anastomoses without signs of pathological inflammation or stenosis in all cases.
  
  
  CONCLUSIONS
  Our results indicate that the novel suture-less CARP is a safe and effective method for creating colonic anastomoses. Further studies are warranted in larger patient populations to compare CARP head-on-head with stapled and/or hand-sewn colonic anastomoses.
authors.affiliation: Department of Clinical Sciences, Section of Surgery, Lund University, 205 02, Malmö, Sweden.
authors.forename: Dadi
authors.initials: D
authors.lastname: Vilhjalmsson
authors.forename: Stefan
authors.initials: S
authors.lastname: Appelros
authors.forename: Ervin
authors.initials: E
authors.lastname: Toth
authors.forename: Ingvar
authors.initials: I
authors.lastname: Syk
authors.forename: Anders
authors.initials: A
authors.lastname: Grönberg
authors.forename: Tommie
authors.initials: T
authors.lastname: Mynster
authors.forename: Henrik
authors.initials: H
authors.lastname: Thorlacius
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012812:Sigmoidoscopy