NEW TECHNIQUE OF COMPRESSION ANASTOMOSIS IN COLORECTAL SURGERY – FIRST RESULTS IN 25 PATIENTS IN MACEDONIA
Journal
Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki)
Date Issued
2016
Author(s)
Aleksandar Mitevski
Aleksandar Karagozov
Abstract
Abstract
Aim: Clinical evaluation of the safety and effectiveness of compression anastomosis with ColonRing™
for large-bowel end-to-end anastomosis for rectal cancer and explanation of the procedure and the
device itself since this device is used for the first time in our clinic.
Material and methods: In November, 2012, a team of surgeons from our clinic attended the Clinical
practice workshop in Belgrade, Serbia which was organized by the World Congress of Compression
Anastomosis (WCCA) and held by its President Prof. Dr. Steven Wexner from Cleveland Clinic in
USA. On this workshop, all aspects of technical point of view were obtained and surgeons were
certified for the technique. A total of 25 patients have been scheduled for elective colorectal surgery
with subsequent compression anastomosis using ColonRing. All patients were operated for high and
mid rectal cancers excluding the low rectal cancers, since those patients are usually diverted with
decompressive ileostomy. Patients, who are diverted, are at higher risk of retaining the ring, after its
dislodgement, in the ampulla of the rectum since they do not have natural excretion of stool via the
anus. All patients were followed for anastomotic leak, anastomotic bleeding, stricture formation,
device (ColonRing) handling in general and time of expulsion of the ring via anus.
Results: We used this technique for the first time in 2013 and since then a total of 25 patients
underwent anterior resection of the rectum with subsequent colorectal compression anastomosis
using ColonRing. Of all patients, 9 were female while 16 were male with median age of 64 years. All
patients were operated for rectal cancers. The mean length of hospital stay was 7.4 days (range 5 to 9
days). None of the patients developed anastomotic bleeding or dehiscence. To date none of the
patients developed anastomotic stricture, although some patients were followed for almost two years.
The average day of expulsion from the body could not be calculated since despite, and although all
patients were given instruction on how to check for ring expulsion, 21 of them did not report this
event. Only 2 patients brought the ring to us. In two cases after 2 week of the initial operation, the
ring was find and palpated on digital rectal examination, free in the ampulla of the rectum and was
easily removed via the anus during the examination. Misfiring was reported in 1 patient (first patient)
and reanastomosis was employed using another ColonRing, No perioperative mortality was observed
in this patient population.
Conclusion: End-to end colorectal anastomosis with the ColonRing is feasible and safe procedure
with fast learning curve. To date, this type of anastomosis is possible in left sided colon lesions
where anastomosis is contemplated below the promontory. We find the device easy to use with high
level of confidence. Further prospective studies including comparison between the ColonRing device
and the conventional staplers evaluating long-term anastomotic complications (i.e., leak or stricture)
are needed to evaluate the benefits and limitations of this device.
Aim: Clinical evaluation of the safety and effectiveness of compression anastomosis with ColonRing™
for large-bowel end-to-end anastomosis for rectal cancer and explanation of the procedure and the
device itself since this device is used for the first time in our clinic.
Material and methods: In November, 2012, a team of surgeons from our clinic attended the Clinical
practice workshop in Belgrade, Serbia which was organized by the World Congress of Compression
Anastomosis (WCCA) and held by its President Prof. Dr. Steven Wexner from Cleveland Clinic in
USA. On this workshop, all aspects of technical point of view were obtained and surgeons were
certified for the technique. A total of 25 patients have been scheduled for elective colorectal surgery
with subsequent compression anastomosis using ColonRing. All patients were operated for high and
mid rectal cancers excluding the low rectal cancers, since those patients are usually diverted with
decompressive ileostomy. Patients, who are diverted, are at higher risk of retaining the ring, after its
dislodgement, in the ampulla of the rectum since they do not have natural excretion of stool via the
anus. All patients were followed for anastomotic leak, anastomotic bleeding, stricture formation,
device (ColonRing) handling in general and time of expulsion of the ring via anus.
Results: We used this technique for the first time in 2013 and since then a total of 25 patients
underwent anterior resection of the rectum with subsequent colorectal compression anastomosis
using ColonRing. Of all patients, 9 were female while 16 were male with median age of 64 years. All
patients were operated for rectal cancers. The mean length of hospital stay was 7.4 days (range 5 to 9
days). None of the patients developed anastomotic bleeding or dehiscence. To date none of the
patients developed anastomotic stricture, although some patients were followed for almost two years.
The average day of expulsion from the body could not be calculated since despite, and although all
patients were given instruction on how to check for ring expulsion, 21 of them did not report this
event. Only 2 patients brought the ring to us. In two cases after 2 week of the initial operation, the
ring was find and palpated on digital rectal examination, free in the ampulla of the rectum and was
easily removed via the anus during the examination. Misfiring was reported in 1 patient (first patient)
and reanastomosis was employed using another ColonRing, No perioperative mortality was observed
in this patient population.
Conclusion: End-to end colorectal anastomosis with the ColonRing is feasible and safe procedure
with fast learning curve. To date, this type of anastomosis is possible in left sided colon lesions
where anastomosis is contemplated below the promontory. We find the device easy to use with high
level of confidence. Further prospective studies including comparison between the ColonRing device
and the conventional staplers evaluating long-term anastomotic complications (i.e., leak or stricture)
are needed to evaluate the benefits and limitations of this device.
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