Anastomosis using the biofragmentable anastomosis ring (ValtracTM BAR) fulfills Senn's criteria for sutureless bowel anastomosis, and has been introduced to current surgical practice. It constructs a secure inverting anastomosis with accurate
serosa-to-serosa apposition until healing occurs. After healing the device fragments and is passed out in the stool.
Sutureless anastomosis using the BAR has been evaluated in a prospective comparison with conventional suture technique for enterocolic surgery in both elective and emergency situations. One hundred and ninety-two patients entered into the study:
87
underwent BAR anastomosis and 105 a two-layer suture anastomosis. BAR anastomosis resulted in five intraoperative complications associated with performance of the anastomosis, which was significantly higher(P<0.01) than in sutured patients in
whom
no
anastomosis-related intraoperative complication occurred. Two pursestrings failed using the pursestring instrument, and the puresetring suture was completed using a manual technique. Insertion of the BAR into the bowel lumen was complicated by
mucosal
tear in two and whole layer tear in one, the latter of which required a smaller new BAR to compete the anastomosis, which was not significant statistically. Nor was there a statistically significant difference in any other postoperative
complications
between the groups. None of five hospital deaths in this study, two in the BAR and three in suture group, was attributed to the anastomosis or to the technique used. Recovery of the gastrointestinal tract was similar in the two groups regarding
time
until flatus, first bowel movement and regular diet. During a mean follow-up o nine months, no additional directly associated with anastomotic technique were developed.
Our data suggest that the ValtracTM BAR is a safe and reliable alternative to conventional suture anastomosis both in elective and emergency bowel surgery. Further evaluation of the BAR will clarify its clinical significance in bowel anastomosis
in
high
risk patients in emergency situations
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