Colon Surgery

The first compression anastomosis device, invented by Felix-Nicholas Denans in 1862, consisted of two metal rings fitted with a central steel spring. This design led to other ring methods, including perhaps the best known anastomotic device, the Murphy button. John Benjamin Murphy developed his device in 1892 as a quick and safe method of intestinal anastomosis. The steel Murphy button had two rounded heads mounted on hollow shafts. After the intestinal ends were tied on the shafts, the heads were screwed together to compress the tissue. However, the Murphy button was believed to be guilty of too tight compression that led to peripheral ischemia and premature necrosis. Further, the central lumen in the device was rather narrow which sometimes caused impaction of intestinal content. Early compression anastomosis devices could not accommodate different tissue thicknesses and other variations in tissue anatomy and therefore could not ensure a uniform necrotic process.

Murphy's button (from: Rutkow IM. John Benjamin Murphy, 1857–1916. Arch Surg 2001;136:359)

It took another 100 years for a new compression anastomosis device to be put into wide use. The BAR, biofragmentable anastomotic ring, device (Sherwood-Davis & Geck, St. Louis, MO) attempted to address the issue of tissue necrosis at the anastomotic site. Its two identical rings have a scalloped shape similar to that of the Murphy button, although there is a 1.5 to 2.5-mm gap between the rings in the closed position to prevent tissue ischemia. As can be surmised by its name, the BAR fragments after a period of time and is expelled from the body. However, the biofragmentation process has been problematic and can cause other postprocedural morbidities, such as bowel obstruction or strictures. Also, the rings cannot accommodate different tissue thicknesses and must be adjusted manually within a range of widths. Other compression technologies include a magnetic compression device and the AKA-2, a transanal compression ring device for proximal rectal anastomosis, which has limited clinical experience.

Valtrac (BAR)