Volume 12 Supplement 1
Sutureless jejuno-jejunal anastomosis in gastric cancer patients: a comparison with handsewn procedure in a single institute
© Marano et al; licensee BioMed Central Ltd. 2012
Published: 15 November 2012
The biofragmentable anastomotic ring has been used to this day for various types of anastomosis in the gastrointestinal tract, but it has not yet achieved widespread acceptance among surgeons. The purpose of this retrospective study is to compare surgical outcomes of sutureless with suture method of Roux-and-Y jejunojejunostomy in patients with gastric cancer.
Two groups of patients were obtained based on anastomosis technique (sutureless group versus hand sewn group): perioperative outcomes were recorded for every patient.
The mean time spent to complete a sutureless anastomosis was 11±4 min, whereas the time spent to perform hand sewn anastomosis was 23±7 min. Estimated intraoperative blood loss was 178±32ml in the sutureless group and 182±23ml in the suture-method group with no significant differences. No complications were registered related to enteroanastomosis. Intraoperative mortality was none for both groups.
The Biofragmentable Anastomotic Ring offers a safe and time-saving method for the jejuno-jejunal anastomosis in gastric cancer surgery, and for this purpose the ring has been approved as a standard method in our clinic. Nevertheless currently there are few studies on upper gastrointestinal sutureless anastomoses and this could be the reason for the low uptake of this device.
The concept of compression anastomosis was introduced for the first time in February 1826 at the meeting of the Societe Royale de Medicine de Marseilles by Felix-Nicholas Denans who performed an end-to-end anastomosis using a metallic (silver or zinc) ring in a canine model . At that time, this technique was still evolving, and in 1892 Murphy developed a new device of compression anastomosis in humans [2–6], which has been called “Murphy’s button”, that was extensively used. However, its clinical success was limited for relatively common anastomotic stenosis . Approximately one century after Murphy, in 1985, Hardy et al  described the biofragmentable anastomotic ring (BAR). This device has been used so far for various types of anastomosis in the upper and lower gastrointestinal tract [6–14], for elective and emergency surgery [8, 10–18], but it has not yet achieved widespread acceptance among surgeons . The purpose of this retrospective study is to compare surgical outcomes of BAR with suture method of Roux-and-Y jejunojejunostomy in patients with gastric cancer who have undergone to total or partial gastrectomy.
Material and methods
Perioperative outcomes of 64 compression end-to-side Roux-and-Y jejunojejunostomy and 59 handsewn end-to-side Roux-and-Y jejunojejunostomy
Compression anastomosis (n=64)
Handsewn anastomosis (n=59)
Estimated intraoperative blood loss
Mean jejunojejunostomy time
Starting time to oral feeding
Mean hospital stay
The usefulness of BAR is well established in colonic anastomoses, but the effectiveness of a compression ring in small bowel anastomoses after gastric cancer surgery has not yet been well proven. Encouraged by little but favorable experiences with the device in colonic surgery we decided to analyze the outcomes of jejuno-jejunal BAR anastomosis compared with jejuno-jejunal hand sewn anastomosis. Our results demonstrate that patients with a jejuno-jejunal BAR anastomosis recover from upper gastrointestinal resections with no delay when compared to those with a manually sutured, conventional anastomosis. The most significant complication associated with anastomosis is anastomotic leakage : although the occurrence of severe complications was lightly more frequent in the suture group (8.5%) when compared with sutureless group (7.8%), they were independent of the enteroanastomosis. In particular, the none overall jejuno-jejunal leak rate in the present study, as exhibited also by other Authors (2-4.2%) [10–14, 17, 18, 22, 23], probably indicate that the compression anastomosis is effective and a safe surgical procedure. Furthermore the surgical technique of BAR anastomosis represents a standardized approach with a very low period of the learning curve. Selection of the appropriate size of the ring and gap width is thought to be one of the critical determinants for a successful BAR anastomosis . In the present study, for ease of use, we preferred to use the ring with external diameter of 28 mm. without any resistance at introduction into bowel lumen for all patients. Another advantage of BAR anastomosis is that it is a faster procedure than hand sewn method, because the mean time of compression procedure is approximately 50% less than the suture procedure, as resulting from our data (11±4 min of BAR anastomoses versus 23±7 min of suture anastomoses (p<0.05)). Therefore it can be applied more preferably to patients with comorbidities where both rapidity and security of the anastomosis is required [14, 16, 17, 22, 23].
In our opinion the Biofragmentable Anastomotic Ring offers a safe and time-saving method for the jejuno-jejunal anastomosis in gastric cancer surgery, and for this purpose the ring has been approved as a standard method in our clinic. Nevertheless, currently there are few studies on upper gastrointestinal BAR anastomoses and this could be the reason for the low uptake of this device.
List of abbreviations used
Biofragmentable Anastomotic Ring.
The authors thank Dr Francesco Torelli for participating at some surgical intervention as surgeon’s assistant.
This article has been published as part of BMC Surgery Volume 12 Supplement 1, 2012: Selected articles from the XXV National Congress of the Italian Society of Geriatric Surgery. The full contents of the supplement are available online at http://www.biomedcentral.com/bmcsurg/supplements/12/S1.
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