Early surgical outcomes of NiTi endoluminal compression anastomotic clip (NiTi CAC 30) use in patients with gastrointestinal malignancy

Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

Purpose

Anastomosis creation after resective gastrointestinal surgery is a crucial task. The present review examines the techniques and implants currently available for anastomosis creation and analyses to which extent they already address our clinical needs, with a special focus on their potential to enable further trauma minimization in visceral surgery.

Methods

A multi-database research was conducted in MEDLINE, Scopus, and Cochrane Library. Comparative controlled and uncontrolled clinical trials dealing with anastomosis creation techniques in the intestinal tract in both German and English were included and statistically significant differences in postoperative complication incidences were assessed using the RevMan5.4 Review Manager (Cochrane Collaboration, Oxford, UK).

Results

All methods and implant types were analyzed and compared with respect to four dimensions, assessing the techniques' current performances and further potentials for surgical trauma reduction. Postoperative outcome measures, such as leakage, stenosis, reoperation and mortality rates, as well as the tendency to cause bleeding, wound infections, abscesses, anastomotic hemorrhages, pulmonary embolisms, and fistulas were assessed, revealing the only statistically significant superiority of hand-suture over stapling anastomoses with respect to the occurrence of obstructions.

Conclusion

Based on the overall complication rates, it is concluded that none of the anastomosis systems addresses the demands of operative trauma minimization sufficiently yet. Major problems are furthermore either low standardization potentials due to dependence on the surgeons' levels of experience, high force application requirements for the actual anastomosis creation, or large and rigid device designs interfering with flexibility demands and size restrictions of the body's natural access routes. There is still a need for innovative technologies, especially with regard to enabling incisionless interventions.

[Colorectal anastomosis using a compression device]

BACKGROUND

The most severe complication following an intestinal anastomosis is the dehiscence with the consequent development of sepsis, fistulas, stenosis, and death. For this reason the compression anastomosis (NiTi) system was developed, with the aim of reducing these complications.

MATERIAL AND METHODS

A retrospective study was conducted, from 1 June 2012 to 30 August 2014, on total of 14 patients operated on the Humanitas Hospital Medical Group Coyoacán, the ASMED, and Clínica Médica Sur. The subjects were predominantly male 65%, a mean age of 58 years, with range 30-79 years.

RESULTS

A total of 14 patients were included. The indication for surgery was complicated diverticular disease Hinchey II-III (36%), and the procedures performed were: 6 (43%) left hemicolectomy with primary end to end compression anastomosis, 2 (14%) major complications (dehiscence wall and anastomosis), 1 (7%) minor complication (infection of the soft tissues). There was a mean 98ml (range 20-300ml) of intraoperative bleeding, with start of oral feeding on the second day, a mean hospital stay of 4 days (range 2-10), one patient with ileo-rectal anastomosis dehiscence presented on the 4th post-operative day, and performing anastomosis with stapling device and loop ileostomy. Stenosis developed in 7% during follow-up and was resolved with a new anastomosis stapler.

CONCLUSIONS

The NiTi device is an additional alternative for colorectal anastomosis, mainly in low anastomosis, obtaining good results in this study without major complications.

Can a nickel-titanium memory-shape device serve as a substitute for the stapler in gastrointestinal anastomosis? A systematic review and meta-analysis

BACKGROUND

Recently, a nickel-titanium (NiTi) memory-shape device has been successfully used in gastrointestinal anastomosis. The aim of this study was to investigate the feasibility and safety of the device.

METHODS

Four databases, reference lists, and the World Health Organization International Clinical Trials Registry Platform were systematically searched for randomized controlled trials assessing the clinical efficacy of a NiTi memory-shape device compared with that of a stapler in gastrointestinal or colorectal anastomosis.

RESULTS

Seven randomized controlled trials regarding the use of compression anastomosis clips (CACs) were enrolled for meta-analysis. The use of CACs was associated with a significant reduction in hospital duration (mean = -0.88 d; 95% confidence interval [CI], -1.38 to -0.38), the time to flatus (mean = -0.36 d; 95% CI, -0.08 to -0.04), and the start of oral intake (mean = -0.45 d; 95% CI, -0.83 to -0.06), as well as a nonsignificant change in postoperative complications and mortality. These clinical outcomes did not significantly change with the use of compression anastomosis rings.

CONCLUSIONS

Colonic anastomosis with a CAC is likely to reduce hospital duration, time to flatus, and the start of oral intake without influencing mortality or postoperative complications and may be a safe and preferable choice in colonic anastomosis. Further well-designed trials should be performed to determine the safety and efficacy of the newly developed compression anastomosis ring in both ileocolic and colorectal anastomosis.

Effects of centralized preoperative interview in patients with gastrointestinal operation

AIM: To investigate the effects of preoperative interview in patients with gastrointestinal operation.

METHODS: One hundred and sixty patients undergoing gastrointestinal operation at People's Hospital of Dongyang City were divided into an observation group and a control groups according to the way of preoperative interview, with 80 cases in each group. The control group received conventional preoperative interview, and the observation group received centralized preoperative interview. The rate of interview, total interview time, anxiety and depression status, complications, and postoperative satisfaction were compared for the two groups.

RESULTS: The rate of interview in the observation group was significantly higher than that in the control group (t = 20.949, P = 0.000), but the total interview time was significantly shorter than the control group (t = 26.881, P = 0.000). Before the intervention, anxiety and depression scores had no statistical differences between the two groups; after intervention, anxiety and depression scores were significantly decreased in both groups, and the decrease was more significant in the observation group (t = 9.438, P = 0.000; t = 8.641, P = 0.000). The numbers of cases of postoperative nausea (t = 21.055, P = 0.000), sore throat (t = 25.004, P = 0.000) and wound infection (t = 5.129, P = 0.024) in the observation group were significantly lower centralized than in the control group. The number of patients who were very satisfied (t = 20.783, P = 0.000) and the total satisfaction (t = 12.471, P = 0.000) were significantly higher in the observation group than in the control group.

CONCLUSION: Centralized preoperative interview can effectively improve the interview rate, shorten the total interview time, improve anxiety and depression, reduce postoperative complications, and improve the patient's satisfaction.