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Tech Coloproctol. 2017 Mar;21(3):177-184. doi: 10.1007/s10151-017-1583-2. Epub 2017 Jan 28.

A systematic analysis of controlled clinical trials using the NiTi CAR™ compression ring in colorectal anastomoses.

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Department of General and Gastrointestinal Surgery, Medical University of Wrocław, Wrocław, Poland.
Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.
Department of Surgical Sciences, University of Turin, Turin, Italy.
Tift College of Education, Mercer University, Atlanta, GA, USA.
Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
Colorectal Surgery Unit, Galliera Hospital, Genoa, Italy.
Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy.
Department of Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy.
Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria.
General (Colorectal), Emergency and Trauma Surgery Service, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health Services, Bologna, Italy.
Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel.
Department of Anatomy, University of Otago, Dunedin, New Zealand.


Anastomotic leak following colorectal surgery can be a devastating adverse event. The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction which potentially contribute to early anastomotic dehiscence or late anastomotic stricture. A systematic review was performed examining available data on controlled randomized and non-randomized trials assessing the NiTi compression anastomosis ring-(NiTi CAR™) (NiTi Solutions, Netanyah Israel) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. A protocol for this meta-analysis has been registered on PROSPERO (CRD42016050934). The initial search yielded 45 potentially relevant articles. After screening titles and abstracts for relevance and assessment for eligibility, 39 of these articles were eventually excluded leaving 6 studies for analysis in the review. Regarding the primary outcome measure, the overall anastomotic leak rate was 2.2% (5/230) in the compression anastomosis group compared with 3% (10/335) in the conventional anastomosis group; this difference was not statistically significant (RR 0.75, 95% CI 0.25-2.24; participants = 565; studies = 6; I 2 = 0%). There were no statistically significant differences between compression and conventional anastomoses in any of the secondary outcomes. This review was unable to demonstrate any statistically significant differences in favor of the compression anastomosis technique over conventional manual or stapled mechanical anastomoses.


Anastomotic leak; BAR; Biofragmentable anastomotic ring; ColonRing; Compression anastomosis; NiTi CAR

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