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GASTROINTESTINAL TRACT ANASTOMOSES WITH THE BIOFRAGMENTABLE ANASTOMOSIS RING: IS IT STILL A VALID TECHNIQUE FOR BOWEL ANASTOMOSIS? ANALYSIS OF 203 CASES
Adam Bobkiewicz*, Lukasz Krokowicz, Adam Studniarek, Jacek Szmeja, Tomasz Banasiewicz
Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
Background
Biofragmentable anastomosis ring (BAR) is a well-known surgical device used for the purpose of bowel anastomosis and it is an alternative to manual and stapled anastomoses performed within the upper and lower gastrointestinal (GI) tract. Although in some countries this technique has been abandoned, in many European countries it is still a method of choice in a number of clinical settings where bowel anastomosis is performed. The aim of this study was to evaluate the effectiveness of BAR utility for bowel anastomoses based on our own material.
Methods
A retrospective analysis was performed to a total of 203 patients who underwent bowel surgery with the use of BAR anastomosis within upper and lower gastrointestinal tract between 2004 and 2014. Data for the analysis was collected based on medical records, treatment protocols, and the results of histological examinations and reviewed in order to analyze patients’ demographics, the indications for surgery and underlying pathology, distribution of BAR sizes, the site of BAR anastomosis as well as intra- and perioperative complications following surgery.
Results
The study group consisted of 86 women and 117 men. The most common underlying pathology was a malignant disease (n = 165). The mean age of patients at the time of surgery was 63,5 (SD=12.4; range from 20 to 88 years). BAR size 31 was the most commonly used (n = 87). A total of 169 colocolic or colorectal anastomoses and 28 ileocolic and 8 enteroenteric anastomoses were performed. Additionally, twenty six patients underwent another simultaneous surgery such as metastatic liver resection (n=6) and cholecystectomy (n=6) as the most common. The mortality rate was 0.5 % (n = 1) whereas re-surgery rate within 30 days was 8.4% (n = 17). Twenty-eight patients developed perioperative complications with surgical site infection as the most common one (n = 11). Eight patients developed specific complications associated with BAR including an anastomotic leak (n = 6) and intestinal obstruction (n = 2). The mean postoperative day when anastomotic leakage was revealed was 9.8 (SD 3.1).The mean time of hospital stay after surgery was 12.7 days.
Conclusions
Technical simplicity, versatility and rapidity makes a BAR technique still an attractive alternative to other types of bowel anastomoses and it is characterized with an acceptable number of perioperative mortality and complication rates. Based on our experience, we recommend the use of BAR anastomosis in different types of intestinal anastomosis in varying clinical scenarios.
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