A Rare Complication Following Anastomosis Suturing Using a Biofragmentable Valtrac© Anastomosis Ring – A Case Review and Literature Overview

Czech version

Authors: L. Lakyová; T. Toporcer; J. Bober; J. Radoňak
Authors‘ workplace: I. chirurgická klinika, Lekárska fakulta Univerzity Pavla Jozefa Šafárika, Košice, Fakultná nemocnica ; L. Pasteura, Košice, Slovenská republika, prednosta kliniky: prof. MUDr. Jozef Radoňak, CSc.
Published in: Rozhl. Chir., 2010, roč. 89, č. 7, s. 446-449.
Category: Monothematic special - Original

Overview

The use of Valtrac Ring since 1985 has brought about the ability of easier anastomosis suturing and shortening of the operative treatment. As other methods, also Valtrac ring has its disadvantages. Authors present a case report of a complication previously not described in the literature.

A 67 year old patient, after right hemicolectomy with ileotransversoanastomosis with the help of Valtrac due to adenocarcinoma, underwent a control colonoscopy six month after operation. Small polyps in colon sigmoideum , colon descendens and transverse were removed and a tissue stripe with ulceration was found during the examination. The bioptic sample was taken from this stripe. After the application of Fragmine, the patient had a massive enterorhagia, which was not even resolved by adrenaline per colonoscopy. The patient underwent re-resection of ileotrasversoanastomosis. A ring of tissue, created by circular necrosis in the place of seroserous connection of biofragmentile ring of both of the lumens, was found in the tissue sample.

Stenosis of the anastomosis, dehiscence, bleeding and fistulation are described in the literature as the most common complications after Valtrac use. The incidence is comparable with complications during anastomosis sutured by hand. We would like to bring this extremely rare complication to the attention to all surgeons and gastroenterologists, who perform endoscopic examinations in patients after this surgical procedure.

Key words:
Valtrac© – necrosis – bowel resection – bleeding

Sources

1. Hardy, T. G., Pace, W. G., Maney, J. W., et al. A biofragmentable ring for sutureless bowel anastomosis : an experimental study. Dis. colon rectum, 1985; 28: 484–490.

2. Bundy, C. A., Jacobs, D. M., Zera, R. T., Bubrick, M. P. Comparision of bursting pressure of sutured, stapled and BAR anastomoses. Int. J. Colorectal Dis., 1993; 8: 1–3.

3. McCue, J. I., Philips, R. K. S. Suturless intestinal anastomosis. Br. J. Surg., 1991; 78, 1291–1296.

4. Konishi, F., Saito, Y., Ugajin, H., Okada, M., Kashiwagi, H., Sato, T., et al. Sutureless anastomosis using a biofragmentable anastomosis ring. Surg. Today, 1995; 25: 783–789.

5. Vrzgula, A., Bober, J., Blažej, I., Vaľko, M., Smola, A. Anastomosis using the Valtrac ring – pro and con. Rozhl. Chir., 2000; 79: 116–119.

6. Kim, S. H., Choi, H. J., Park, K. J., Kim, J. M., Kim, K. H., Kim, M. C. H., et al. Sutureless Intestinal ansatomosis with biofragmentable anastomosis ring: experience of 632 anastomoses in a sigle institute. Dis. Colon and rectum, 2005; 48 : 2127–2132.

7. Grassi, R., De Rossa, R., Greco, M., Cappabianca, S., Monaco, L., Izzo, G., De Martino, N. Abdominal radiography findings in small bowel nantomoses with V-Bar. Radiol. Med., 2005; 109: 527–531.

8. Chen, S., Yang, B., He, J., Zhang, Y., Lai, D. Randomized trial on the application of biofragmentable anastomosis ring in intestinal anastomosis. Chinese Medical Journal, 2009; 122: 1755–1758.

9. Ghitulescu, G. A., Morin, N., Jetty, P., Belliveau, P. Revisiting the biofragmentable anastomotic ring: Is it safe in colonic surgery? Can. chir., 2003; 46: 92–98.

10. Debus, E. S., Sailer, M., Geiger, D., Dietz, U. A., Fuchs, K.-H., Thiede, A. Long-Term Results after 75 Anastomoses in the Upper Extraperitoneal Rectum with the Biofragmentable Anastomosis Ring. Dig. Surg., 1999; 16 : 55–59.

11. Di Castro, A., Biancari, F., Brocato, R., Adami, E. A. Truosolo, B., Massi, G. Intestinal Anastomosis with the Biofragmentable Anastomosis Ring. Am. J. Surg., 1998; 176: 472–474.

12. Penka, I., Kaplan, Z., Sefr, R., Simoník, I. Late posoperative colonic stenosis cause by the biofragmentable anastomosis rong BAR. Rozhl. Chir., 2000; 79: 429–432.

13. Bubrick, M. P., Corman, M. L., Cahill, C. J., Hardy, T. G., Nance, F. C., Shatney, C. H. Prospective, randomized trial of the biofragmentable anastomosis ring. The BAR Investigational group. Am. J. Surg., 1991; 161: 136–142.

14. Gullichsen, R., Havia, T., Ovaska, J., Rantala, A. Colonic anastomosis using biogragmentable anastomotic ring and manual suture: a prospective, randomized study. Br. J. Surg., 1992; 79: 578–580.

15. Cossu, M. L., Coppola, M., Fais, E., Ruggiu, M., Sparta, C., Profili, S., Bifulco, V., Meloni, G. B., Noya, G. The use of the Valtrac ring in the upper and lower gastrointestinal tract, for single, double, and triple anastomoses : a report of 50 cases. Am. Surg., 2000; 66: 759–762.

16. Thiede, A., Geiger, D., Dietz, U., et al. Overview on compression anastomosis by use of the biogragmentable anastomotic ring: it is safe and efficacious in emergency operations as well? Dis. colon rectum, 1998; 41: 1281–1286.

17. Mokros, W. Indikationgerechte Anwendung des Valtrac© – Ringes bei der Anastomosentechnik Ehrfahrungsbericht über 1015 Anastomosen. Zentralbl. Chir., 2001; 126: 1005–1008.

18. Forde, K. A., McLarty, A. J., Tsai, J., Ghalili, K., Delany, H. M. Murphy‘s button revisited: Clinical experience with biofragmentable anastomotic ring. Ann. Surg., 1993; 217: 78–81.