[Comparison of efficiency and safety of laparoscopic manual esophagoenterostomy and esophagoenterostomy with mechanical anastomotic devices after laparoscopic gastrectomy for stomach cancer]. / Sravnenie bezopasnosti i effektivnosti primeneniya metodiki ruchnogo intrakorporal'nogo ezofagoenteroanastomoza i apparatnogo ezofagoenteroanastomoza s ispol'zovaniem lineinykh sshivayushchikh apparatov posle laparoskopicheskoi gastrektomii po povodu raka zheludka.

OBJECTIVE: To compare laparoscopic manual esophagoenterostomy and esophagoenterostomy with mechanical stapling anastomotic devices after laparoscopic gastrectomy for stomach cancer. MATERIAL AND METHODS: There were 34 patients who underwent laparoscopic gastrectomy for stomach in 2015-2018. Roux-en-Y esophagoenterostomy was used to reconstruct the gastrointestinal tract. Manual anastomoses were performed in 18 patients (group 1), stapled anastomoses (endogia 45 mm, covidien, mansfield, ma, usa) - in 16 patients (group 2). There was no randomization. Surgery duration, length of icu-stay, terms of enteral nutrition initiation, postoperative complications, hospital-stay were analyzed. RESULTS: Mean duration of surgery in the first group was 217 (184-302) min, in the second group - 201 (162-311) min. Duration of surgery in the first group was 1.08-fold higher than in the second group (95% CI 1.03-1.13, p=0.05). Mean blood loss was 145 ml in both groups. Mean icu-stay was 20.2 (17-42) hours in the first group and 21.1 (16.2-46) hours in the second group (ratio 0.96, 95% CI 0.92-1.01, p=0.06). Total enteral feeding (sipping) was initiated on the third day in both groups. Mean postoperative hospital-stay was 9.21 (6-13) days in the first group and 9.23 (6-12 days) days in the second group (ratio 0.99, 95% CI 0,95-1.02, p=0.06). Postoperative morbidity was 5.5% in the first group and 6.25% in the second group. CONCLUSION: Laparoscopic manual esophagoenterostomy proposed by our surgical team does not have disadvantages in comparison with stapling anastomotic devices and these methods may be alternative to each other.

[Hardware anastomosis in stomach cancer surgery]. / Apparatnyi anastomoz v khirurgii raka zheludka.

AIM: To choose optimal technique of esophagojejunostomy in stomach cancer regarding reliability, functionality and simplicity. MATERIAL AND METHODS: 145 patients with stomach cancer grade I-IV were enrolled. They were divided into 2 groups depending on the type of the anastomosis (manual or hardware). RESULTS: There were no significant differences between groups in the incidence of anastomosis failure, anastomotic stricture and reflux-esophagitis in long-term postoperative period. At the same time, duration of reconstructive stage with hardware anastomosis was 26±11.3 min, whereas for manual stage - 72±21.9 min (p<0.0001) depending on surgeon's experience. CONCLUSION: Hardware circular anastomosis in most clinical cases is an alternative to conventional manual anastomosis with the same reliability, safety and functionality. Moreover, principles of hardware anastomosis are the same for open and endoscopic surgery that makes this technique universal and necessary for wide development.

[FORMATION OF BILIODIGESTIVE AND INTERINTESTINAL ANASTOMOSES IN ENVIRONMENT OF BILIARY PERITONITIS, USING A HIGH FREQUENCY ELECTRIC WELDING IN EXPERIMENT].

In experiment on 20 rabbits a diffuse biliary peritonitis was simulated, using intraabdominal injection of a laboratory culture of E. coli suspension and a medicinal bile. In 24 h on background of peritonitis on excluded loop of a small bowel in accordance to method of Roux, using a high frequency electric welding with the help of apparatus Patonmed EKB3-300 a one-layered everting cholecystoenteroanastomosis and enteroenteroanastomosis was formated. In a 6 mo postoperatively a connection line was not revealed from outside or from inside, the signs of stenosis were absent. In environment of a diffuse biliary peritonitis a welding technologies have permitted to form a hermetic and competent biliodigestive and interintestinal anastomoses, the processes of a welding suture regeneration postoperatively have a typical course. Using a high frequency-electric welding it is possible to perform a one-staged reconstructive interventions in environment of a pronounced inflammation of tissues due to subsequent precise conjunction of mucosal sheets of connected organs, preventing the anastomotic stricture formation.

A new option for intracorporeal circular-stapled esophagojejunostomy in laparoscopic total gastrectomy: Roux-en-Y reconstruction with its efferent loop located at the left side of the patient to prevent twisting of the esophagojejunostomy.

BACKGROUND/AIMS: Laparoscopic total gastrectomy (LTG) has not gained widespread acceptance because of the difficult reconstruction technique, especially for esophagojejunostomy. Although various modified procedures using a circular stapler for esophagojejunostomy have been reported, an optimal technique has not yet been established. In addition, in intracorporeal techniques, twisting of the esophagojejunostomy, which might be the cause of stenosis, is often encountered because application of the shaft is restricted. To prevent twisting of the esophagoejunostomy, we underwent LTG with Roux-en-Y reconstruction with its efferent loop located at the left side of the patient. METHODOLOGY: From November 2013 to November 2014, a series of 9 patients underwent LTG with Roux-en-Y reconstruction using the transorally inserted anvil (OrVil™, Covidien, Mansfield, MA, USA), whose efferent loop was located at the left side of the patient. RESULTS: No twisting of the esophagojejunostomy was encountered in all cases. In addition, no stenosis or leakage of the esophagojejunostomy occurred. CONCLUSIONS: This reconstruction system may be a feasible surgical procedure in LTG.

A safe anastomotic technique of using the transorally inserted anvil (OrVil) in Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy for proximal malignant tumors of the stomach.

BACKGROUND: To explore the safety and feasibility of the transorally inserted anvil (OrVil) in laparoscopy-assisted total gastrectomy for gastric cancer. METHODS: From December 2010 to June 2011, a total of 28 patients underwent laparoscopy-assisted total gastrectomy with a Roux-en-Y-esophagojejunostomy anastomosis with OrVil. Perioperative treatments, intraoperative data, postoperative complications and hospital length of stay were evaluated. RESULTS: There were no conversions to the open gastrectomy. The mean operation time was 143 minutes and the mean blood loss was 70 ml. Patients resumed an oral liquid diet on postoperative days 4 to 5. Two patients (7%) who suffered postoperative aspiration pneumonia were cured by conservative treatment. The median hospital length of stay was 9.6 days (8 to 11 days), with no inhospital mortalities. The median follow-up time was 14.8 months (12 to 18 months), and postoperative endoscopic examination revealed no anastomosis stenosis in patients who had dysphagia. CONCLUSION: The use of the OrVil is technically feasible and relatively safe for Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy.

Roux-en-Y choledochojejunostomy using novel magnetic compressive anastomats in canine model of obstructive jaundice.

BACKGROUND: The traditional hand-sewn Roux-en-Y choledochojejunostomy is technically complicated, and the incidence of postoperative complications has remained high. A set of novel magnetic compressive anastomats was introduced to facilitate choledochojejunostomy and improve the prognosis of patients. METHODS: After ligating the common bile duct for 7 days, 16 dogs were randomly divided into two groups (n=8 per group). Anastomats were used in the study group, and the traditional hand-sewn method was used in the control group for standard Roux-en-Y choledochojejunostomy. We compared the operation time, incidence of complications, gross appearance, and pathological disparity in stoma between the two groups in 1-month and 3-month follow-up examinations. RESULTS: The time spent on constructing the anastomosis for the study group was significantly shortened. Although no anastomotic stenosis occurred in the two groups, the narrowing rate of biliary-enteric anastomosis was much higher in the control group. There was one case of bile leakage in the control group, whereas no bile leakage occurred in the study group. A smoother surface, an improved layer apposition, and a lower local inflammatory response were identified in the anastomosis of the study group. CONCLUSION: The structures of the novel magnetic compressive anastomats are simple, and they are time-saving, safe and efficient for performing Roux-en-Y choledochojejunostomy procedures in a canine model of obstructive jaundice.

Sutureless jejuno-jejunal anastomosis in gastric cancer patients: a comparison with handsewn procedure in a single institute.

BACKGROUND: 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. METHODS: Two groups of patients were obtained based on anastomosis technique (sutureless group versus hand sewn group): perioperative outcomes were recorded for every patient. RESULTS: 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 ± 32 ml in the sutureless group and 182 ± 23 ml in the suture-method group with no significant differences. No complications were registered related to enteroanastomosis. Intraoperative mortality was none for both groups. CONCLUSIONS: 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.

A novel procedure for Roux-en-Y reconstruction following laparoscopy-assisted distal gastrectomy: transoral placement of anvil and intracorporeal gastrojejunostomy via umbilical mini-laparotomy.

We describe herein our procedures for Roux-en-Y reconstruction using a transoral anvil following laparoscopy-assisted distal gastrectomy (LADG). The procedure consists of three technical processes: transoral placement of the anvil with the head pre-tilted, extracorporeal preparation of the Roux-en-Y limb, and intracorporeal gastrojejunostomy with a circular stapler introduced via an umbilical mini-laparotomy. We applied the procedure to 33 patients with early gastric cancer between December 2008 and June 2010. None of the patients suffered from surgical complications related either to the transoral placement of the anvil or the anastomoses. The postoperative wound appearance was much less conspicuous than that of conventional laparoscopic distal gastrectomy, because our procedure needed only a 4-cm mini-laparotomy on the umbilicus, except for the trocar ports. This technique involving transoral anvil placement enables intracorporeal anastomosis for gastrojejunostomy via an umbilical mini-laparotomy, and may be one of the surgical choices for anastomosis and Roux-en-Y reconstruction following LADG.

Efficacy of NiTi Hand CAC 30 for jejunojejunostomy in gastric cancer surgery: results from a multicenter prospective randomized trial.

BACKGROUND: Although a novel technique for the performance of intestinal sutureless anastomosis using a compression device has recently been investigated, it has not yet received widespread acceptance. We performed a multicenter prospective randomized trial in order to determine the clinical efficacy of the NiTi Hand CAC 30, a type of compression anastomosis clip (CAC), for jejunojejunostomy in gastric cancer surgery. METHODS: Forty-seven patients from 6 institutions, who were diagnosed with gastric adenocarcinoma, were enrolled; these patients were randomized to a CAC group and a hand-sewn (control) group. Three patients dropped out for various reasons, and results for 44 patients were finally analyzed. The CAC group consisted of 20 patients, and there were 24 patients in the control group. RESULTS: Anastomosis time, the primary endpoint of this trial, was shorter in the CAC group than in the control group (P < 0.001). However, total operation times (P = 0.055) did not differ. All reconstructions were completed by Roux-en-Y anastomosis, and the complication rates of the two groups did not differ (P = 0.908); however, jejunojejunostomy leakage occurred in two patients in the CAC group. CONCLUSIONS: Our prospective multicenter clinical trial showed that the use of the NiTi Hand CAC™ 30 for jejunojejunostomy in gastric cancer surgery was feasible and could reduce anastomosis time. However, considering that there were two cases of leakage, extended use of the NiTi Hand CAC™ 30 should be carefully applied.

Application of the transorally inserted anvil (OrVil) after laparoscopy-assisted total gastrectomy.

BACKGROUND: Laparoscopy-assisted total gastrectomy (LATG) is not a commonly performed procedure due to the surgical difficulty associated with reconstruction. Although various reconstruction methods have been reported, a standard technique has not yet been established. In this study, we compared the short-term outcomes of LATG reconstructed by mini-laparotomy and by the newly developed transorally inserted anvil (OrVil). METHODS: From April 2006, a series of 45 patients underwent LATG. Of these, 15 were reconstructed by mini-laparotomy and 30 by OrVil. Short-term outcomes were compared between the two groups. RESULTS: Operation time was significantly shortened and intraoperative blood loss significantly reduced by the use of OrVil. The postoperative course, including morbidity, did not differ between the two groups. CONCLUSIONS: LATG using OrVil for the treatment of early gastric cancer is a technically feasible surgical procedure with sufficient lymph node dissection, satisfactory early recovery, and acceptable morbidity. It will be necessary to perform this novel technique in a large number of patients to confirm its feasibility.

Double suturless hepaticojejunostomy.

In iatrogenic lesions of the main bile duct, especially when the injury is above the level of the hepatic bifurcation, the surgeon ought to use two short and thin biliary stumps. It is necessary to perform separate anastomoses, using a "Y loop" and creating a double hepaticojejunostomy. Technical difficulties increase when the biliary ducts are thinner, tighter and separated from one another for a distance more than 2 cm. In such case we have attempted to develop a double sutureless hepaticojejunostomy by simply keeping the bilioenteric partners in apposition with continuous traction exerted via the biliary stents.

A modified method of using laparoscopic compression anastomosis clip for gastrointestinal anastomosis.

The aim of this study was to validate a modified method of using a laparoscopic compression anastomosis clip (LapCAC) for gastrointestinal anastomosis in an animal experiment and two clinical cases. Anastomotic surgery of the upper digestive tract was performed on dogs using the conventional and modified methods for LapCAC. The animals were sacrificed postoperatively at different time points to obtain sections from the anastomotic site for pathologic study. Anastomotic outcomes of the two methods were also verified in two clinical cases. The animal experiments and the two clinical cases showed that no anastomotic leakage occurred with the modified method, and that the new method was simple, convenient and reliable as compared with the conventional method. The mean time of placing the anastomosis clip was shorter, and the mean numbers of operation attempts, secondary actions and sutures in the operating holes were reduced. The serosa at the anastomosis healed completely, the muscular layer and submucosal fibers proliferated well, and the anastomosis was covered with mucosa within two weeks after the operation. LapCAC offered a better surgical outcome when it was used according to the modified method, where anastomoses formed smoothly and completely within two weeks after the operation.

A Preclinical Animal Study of Combined Intragastric Balloon and Duodenal-Jejunal Bypass Liner for Obesity and Metabolic Disease.

INTRODUCTION: Endoscopic bariatric and metabolic therapies can potentially reproduce similar gastric and small intestinal anatomic and physiologic manipulations as Roux-en-Y gastric bypass. This proof of concept animal study was aimed to assess the feasibility, safety, efficacy, and impact on gastrointestinal physiology of combined intragastric balloons (IGB) and duodenal-jejunal bypass liner (DJBL) for the treatment of obesity. METHODS: Five Ossabaw pigs were fed a high-calorie diet to develop obesity and were randomly assigned to receive IGB or DJBL in sequence. The weight gain rate was calculated. Fasting and postprandial blood samples were drawn before any intervention (serving as the baseline group) and 1 month after second device insertion (serving as the combination group) to measure gut neurohormonal changes and metabolic parameters. RESULTS: Four pigs successfully received a sequential device insertion. One pig developed duodenal sleeve prolapse that was spontaneously resolved. One pig was early terminated because of developing a central line infection. The rate of weight gain in the combination group (0.63 ± 1.3 kg/wk) was significantly lower than the baseline group (1.96 ± 2.17 kg/wk) and numerically lower than after insertion of the IGB (1.00 ± 1.40 kg/wk) or the DJBL (0.75 ± 2.27 kg/wk) alone. A trend of higher postprandial glucagon-like peptide-1 was observed in the combination group compared with the baseline group. DISCUSSION: A combination of IGB and DJBL is feasible and well tolerated. A strategy of sequential use of these devices might offer a synergistic approach that can enhance weight loss and metabolic outcomes.

Endoscopic retrograde cholangiopancreatography with single-balloon enteroscopy is feasible in patients with a prior Roux-en-Y anastomosis.

The purpose of this study is to describe the feasibility of using single-balloon enteroscopy (SBE) to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients who had a prior Roux-en-Y (RY) anastomosis. This case series describes four patients, one with RY gastric bypass, two with RY due to bile duct injury, and one with RY after liver transplantation, who underwent ERCP with SBE. Cholangiography was successful in three of the four patients. In the procedure that was not successful, the enteroenterostomy site could not be located. The successful procedures ranged from 65-91 min in duration. Medication doses were higher than with typical ERCPs. No procedural complications occurred. SBE for ERCP is a feasible option for endoscopic access to the biliary tree in patients with prior RY anastomoses. Limitations of this technique include the time requirement, delay in identification of the enteroenterostomy site, potential learning curve, and immature technology lacking accessories.

Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy.

BACKGROUND: Laparoscopic total gastrectomy (LTG) has not become as popular as laparoscopic distal gastrectomy (LDG) because of the more difficult reconstruction technique. Despite various modifications of reconstruction methods after LTG, an optimal procedure has yet to be established. The authors report the newly developed reconstruction technique after LTG: intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil; Covidien, Mansfield, MA, USA). METHODS: After full mobilization of the abdominal esophagus, the esophagus is transected with an endoscopic linear stapler. The anvil is then transorally inserted into the esophagus by using the OrVil system. After jejunojejunostomy is performed through a 4-cm midline minilaparotomy, preparing a 50-cm Roux-en-Y jejunal limb, a circular stapler is inserted into the jejunum and introduced into the abdominal cavity. Pneumoperitoneum is established by sealing off the laparotomy wound retractor with a surgical glove attached to the circular stapler. Double-stapling esophagojejunostomy with a circular stapler is performed intracorporeally, and the jejunal stump is closed with an endoscopic linear stapler. RESULTS: Of the 16 patients who underwent this operation, there was no intraoperative complication or conversion to open surgery, and no patient required an extension of the initial incision for anastomosis. Mean operation time and blood loss were 194 min and 272 ml, respectively. One patient developed an intra-abdominal abscess postoperatively. Postoperative fluorography revealed no anastomosis leakage or stenosis in any of the patients. Patients resumed an oral liquid diet on postoperative day 3-5, and the mean postoperative hospital stay was 11 days. CONCLUSIONS: We have successfully performed LTG with Roux-en-Y reconstruction using our technique in 16 patients without any anastomosis complications. We believe that our procedure is a secure and reliable reconstruction method after LTG, which is especially useful in obese patients, in whom conventional extracorporeal anastomosis often is difficult.

ERCP using double-balloon endoscopes in patients with Roux-en-Y anastomosis.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) and associated procedures are difficult to perform in patients with a Roux-en-Y reconstruction. Therefore, at present, at many institutions, ERCP is not generally performed for those with a Roux-en-Y anastomosis. METHODS: However, double-balloon endoscopes (DBEs) have dramatically changed this situation. RESULTS: The use of a DBE enables an endoscopic approach into the deeply situated small intestine, which has been difficult with a conventional endoscope. Therefore, ERCP for patients with a Roux-en-Y anastomosis has been attempted using a DBE, and good results have been reported. CONCLUSION: The development of DBEs has created the possibility of performing ERCP for patients with Roux-en-Y reconstruction in whom an endoscopic approach has conventionally been believed to be difficult.

Gastric remnant perforation due to trocar site herniation after laparoscopic Roux-en-Y gastric bypass.

A 39-year-old woman was admitted with colicky left upper-quadrant pain, dyspnoea, low-grade fever, tachycardia and a subtle left upper-quadrant tenderness without leucocytosis. Computed tomography revealed a distended gastric remnant due to small-bowel loop herniation at the trocar site. The patient underwent a diagnostic laparoscopy as her general condition worsened. Perforation across the staple line was seen and repaired. The postoperative period was uneventful. As a rare complication of laparoscopic Roux-en-Y gastric bypass, small-bowel obstruction is of great importance because it can lead to gastric remnant perforation if not managed correctly. There have been rare reports of trocar site herniation as a cause of small-bowel obstruction following laparoscopic Roux-en-Y gastric bypass. Prompt diagnostic laparoscopy should be considered. This is the first case reported in which the excluded stomach was perforated due to trocar site herniation of the small-bowel loop. It should be noted that the tissue around the perforation is fragile and proper tension should be employed when it is repaired. Generally, an omental patch is not encouraged.

Gastrojejunal stomal reduction with the T-tag device in porcine models (with videos).

BACKGROUND: Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Gastrojejunal (GJ) stomal dilatation associated with weight regain is a late complication. Surgical revision is usually required for stomal or pouch reduction. OBJECTIVE: Our purpose was to evaluate the technical feasibility, efficacy, and safety of stomal reduction with endoscopic T-tag devices. DESIGN: Prospective nonsurvival studies were conducted in pigs (n = 2, 110 pounds each). INTERVENTIONS: Three GJ stomas were created in each pig through a midline laparotomy by using circular staplers. Endoscopic GJ stomal reduction/revision was performed on these newly created stomas with an Olympus T-tag device. Necropsy was performed to examine the deployed T-tag locations and procedure-related adjacent tissue/organ injury and to assess the effectiveness of stomal reduction. RESULTS: Endoscopic stomal revision was performed on 5 stomas with moderate stomal reduction. One GJ stoma could not be accessed easily by endoscopy because of the small size of the gastric pouch. An average of 4 T-tag devices was deployed around each stoma. The procedural time was about 61 +/- 12 minutes for each stomal reduction. Overall, 26 of 39 (66.7%) T-bars were deployed in accepted locations. The stomas were reduced from 1.60 +/- 0.21 mm x 1.44 +/- 0.14 mm to 1.28 +/- 0.29 mm x 0.98 +/- 0.17 mm and the percentage of stomal reduction was 27.3% +/- 13.3%. In the end, a therapeutic gastroscope could not be advanced through the reduced stomas. In 2 stomas, 5 of 39 (12.8%) T-bars injured or attached to the adjacent organs: isolated stomach and abdominal wall. LIMITATION: Nonsurvival pig studies. CONCLUSIONS: Endoscopic stomal reduction with T-tag device is technically feasible and effective in two thirds of trials. However, it is associated with a small risk of adjacent organ/tissue injury with the current prototype device and deployment method.

Application of a new type of sutureless magnetic biliary-enteric anastomosis stent for one-stage reconstruction of the biliary-enteric continuity after acute bile duct injury: an experimental study.

BACKGROUND: The bile duct cannot be repaired or reconstructed in one stage after 24 h of bile duct injury due to significant inflammation. Even if the bile duct can be repaired, anastomosis is difficult because of the extremely technical nature of the procedure. The traditional method of anastomosis utilizes screw thread. This would increase the inflammatory response, delay anastomotic healing, and lead to the increase in the failure rate. To reconstruct the biliary-enteric continuity under the circumstance of severe inflammation after bile duct injury, we invented a new type of anastomotic apparatus (sutureless magnetic stent) for cholangiojejunostomy. The objective of this study was to evaluate the effect of a new type of sutureless magnetic biliary-enteric anastomosis stent, which was used to reconstruct the biliary-enteric continuity in one stage. The reconstruction was conducted under the circumstance of severe inflammation after acute bile duct injury in dogs. METHODS: We used a model of acute bile duct injury and bile peritonitis in dogs. The sutureless magnetic biliary-enteric anastomosis stents was used to reconstruct the biliary-enteric continuity in one stage under the circumstance of a bile duct with severe inflammation. The effect of stents was observed. Cholangiography and anastomotic histology were examined at 1 mo and compared with traditional manual anastomosis. RESULTS: Anastomotic stents were used to reconstruct the biliary-enteric continuity in one stage in dogs. No anastomotic leak or infection occurred. Cholangiography showed that the anastomosis was unobstructed. Histological examinations showed that the anastomosis healed well, the inflammatory reaction was small, and collagen fibers lined up in order. There was high incidence of bile leakage in the conventional suture group. Cholangiography showed that anastomotic stenosis was high. Histological examination showed that there was more extensive inflammation around the anastomosis and the collagen fibers were disorganized. CONCLUSION: It was safe and feasible to use the new type of anastomosis stent to reconstruct the biliary-enteric continuity in one stage under the circumstance of severe bile duct inflammation after bile duct injury in dogs.

Compression anastomosis clip for gastrointestinal anastomosis.

AIM: To investigate the feasibility of compression anastomosis clip (CAC) for gastrointestinal anastomosis proximal to the ileocecal junction. METHODS: Sixty-six patients undergoing gastrointestinal anastomosis proximal to the ileocecal junction were randomized into two groups according to the anastomotic method, CAC or stapler. RESULTS: The postoperative recovery of patients in CAC and stapled anastomosis groups was similar. No postoperative complication related to the anastomotic method was found in either group. Both upper gastrointestinal contrast radiography at the early postoperative course and endoscopic examination after a 6-mo follow-up showed a better healing at the compression anastomosis. CONCLUSION: CAC can be used not only in colonic surgery but also in gastrointestinal anastomosis. Our result strongly suggests that CAC anastomosis is safe in various complication circumstances. However, it should be further confirmed with a larger patient sample.