New concepts for a compression anastomosis: superelastic clips and rings.

Gastrointestinal anastomosis is a crucial step in many operative procedures, and responsible for a major portion of early and late post-operative complications. In order to improve on the results of current tools to perform an anastomosis, such as sutures and staplers, new concepts are being developed. One of these concepts is compression anastomosis. Compression anastomosis has been tried in the past but did not become popular mostly because of technical reasons. Recently, trials to accomplish compression anastomosis using Nitinol devices were conducted. Two devices were made and tested in the past three years: a side-to-side device and an end-to-end device. The common principle in both devices is the compression of two bowel loops through the constant pressure of a Nitinol device, thus producing a dual process of necrosis and healing until the lumens of both bowels fuse, and the device falls into the lumen and is excreted. Both devices have been tested in animals and humans, with encouraging results. In animals, the anastomoses were shown to demonstrate minimal inflammation and no foreign body reaction, with perfect healing of the mucosa. The side-to-side device was tested in over 500 human patients, and the end-to-end device is currently used in a large, multi-centric human trial.