title: A systematic analysis of controlled clinical trials using the NiTi CAR™ compression ring in colorectal anastomoses.
abstract: Anastomotic leak following colorectal surgery can be a devastating adverse event. The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction which potentially contribute to early anastomotic dehiscence or late anastomotic stricture. A systematic review was performed examining available data on controlled randomized and non-randomized trials assessing the NiTi compression anastomosis ring-(NiTi CAR™) (NiTi Solutions, Netanyah Israel) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. A protocol for this meta-analysis has been registered on PROSPERO (CRD42016050934). The initial search yielded 45 potentially relevant articles. After screening titles and abstracts for relevance and assessment for eligibility, 39 of these articles were eventually excluded leaving 6 studies for analysis in the review. Regarding the primary outcome measure, the overall anastomotic leak rate was 2.2% (5/230) in the compression anastomosis group compared with 3% (10/335) in the conventional anastomosis group; this difference was not statistically significant (RR 0.75, 95% CI 0.25-2.24; participants = 565; studies = 6; I2= 0%). There were no statistically significant differences between compression and conventional anastomoses in any of the secondary outcomes. This review was unable to demonstrate any statistically significant differences in favor of the compression anastomosis technique over conventional manual or stapled mechanical anastomoses.
authors.affiliation: Department of General and Gastrointestinal Surgery, Medical University of Wrocław, Wrocław, Poland.
authors.forename: R
authors.initials: R
authors.lastname: Tabola
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. roberto.cirocchi@unipg.it.
authors.forename: R
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Fingerhut
authors.affiliation: Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Arezzo
authors.affiliation: Tift College of Education, Mercer University, Atlanta, GA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Randolph
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Grassi
authors.affiliation: Colorectal Surgery Unit, Galliera Hospital, Genoa, Italy.
authors.forename: G A
authors.initials: GA
authors.lastname: Binda
authors.affiliation: Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: D'Andrea
authors.affiliation: Department of Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Abraha
authors.affiliation: Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria.
authors.forename: G
authors.initials: G
authors.lastname: Popivanov
authors.affiliation: General (Colorectal), Emergency and Trauma Surgery Service, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health Services, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Di Saverio
authors.affiliation: Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel.|Department of Anatomy, University of Otago, Dunedin, New Zealand.
authors.forename: A
authors.initials: A
authors.lastname: Zbar
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D003106:Colon / Q000601:surgery*; D018849:Controlled Clinical Trials as Topic; D006801:Humans; D011312:Pressure; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
keywords: Anastomotic leak; BAR; Biofragmentable anastomotic ring; ColonRing; Compression anastomosis; NiTi CAR