Comparison of the C-REX LapAid and Circular Stapled Colorectal Anastomoses in an Experimental Model
(2025) In European Surgical Research 66(1). p.9-17- Abstract
The rate of colorectal
anastomotic leakage has remained unchanged for the last decades. The
limitations of current anastomotic methods have generated an interest in
alternative anastomotic techniques, such as compression anastomosis.
The aim of this experimental study was to evaluate the early mechanical
strength in left colonic anastomoses, comparing C-REX LapAid and
circular stapled anastomotic methods. Methods: A total of 48 pigs
underwent open sigmoid resection with end-to-end colorectal anastomoses
15 cm above the anal verge, where 21 anastomoses were constructed with
traditional circular staplers and 27 with the C-REX LapAid device.
Bursting pressure was measured at different time... (More)The rate of colorectal
(Less)
anastomotic leakage has remained unchanged for the last decades. The
limitations of current anastomotic methods have generated an interest in
alternative anastomotic techniques, such as compression anastomosis.
The aim of this experimental study was to evaluate the early mechanical
strength in left colonic anastomoses, comparing C-REX LapAid and
circular stapled anastomotic methods. Methods: A total of 48 pigs
underwent open sigmoid resection with end-to-end colorectal anastomoses
15 cm above the anal verge, where 21 anastomoses were constructed with
traditional circular staplers and 27 with the C-REX LapAid device.
Bursting pressure was measured at different time intervals
postoperatively through an attached anal plug while the upper limit of
the bowel segment was closed with a bowel clamp. Early histological
changeswere assessed 6-24 h after the anastomotic formation with
vascular CD31 and collagen Masson Trichrom staining. Results: All
animals recovered uneventfully after the surgical procedure. The
circular stapled anastomoses exhibited a median bursting pressure of 36
mbar (28-64) at 1 h, 45 mbar (43-69) at 6 h, and 145 mbar (85-185) 12 h
after surgery. In comparison, the C-REX LapAid anastomoses demonstrated a
median bursting pressure of 195 mbar (180-240) at 1 h, 192 mbar
(180-220) at 6 h, and 180 mbar (160-180) 12 h after surgery,
representing a 2-5-fold higher median bursting pressure in the early
anastomotic healing phase. Early microscopic architecture showed little
evidence of vascular and collagen formation. Conclusion: The novel C-REX
LapAid device demonstrated significantly higher bursting pressure
values in the early phase of the anastomotic healing process compared to
the circular stapled method. A clinical study to further verify the
benefitsofC-REXLapAid iswarranted.
- author
- Vilhjalmsson, Dadi Thor LU ; Grönberg, Anders ; Syk, Ingvar LU and Thorlacius, Henrik Tobias LU
- organization
- publishing date
- 2025-02
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Anastomotic leakage, C-REX, CARP, Compression anastomosis, LapAid, RectoAid
- in
- European Surgical Research
- volume
- 66
- issue
- 1
- pages
- 9 pages
- publisher
- Karger
- external identifiers
-
- pmid:39933492
- scopus:105000639558
- ISSN
- 0014-312X
- DOI
- 10.1159/000543069
- language
- English
- LU publication?
- yes
- id
- 3e398c11-617c-4476-8bc6-95f0013df9fe
- date added to LUP
- 2025-08-26 13:29:40
- date last changed
- 2025-08-27 03:00:03
@article{3e398c11-617c-4476-8bc6-95f0013df9fe,
abstract = {{<p>The rate of colorectal <br>
anastomotic leakage has remained unchanged for the last decades. The <br>
limitations of current anastomotic methods have generated an interest in<br>
alternative anastomotic techniques, such as compression anastomosis. <br>
The aim of this experimental study was to evaluate the early mechanical <br>
strength in left colonic anastomoses, comparing C-REX LapAid and <br>
circular stapled anastomotic methods. Methods: A total of 48 pigs <br>
underwent open sigmoid resection with end-to-end colorectal anastomoses <br>
15 cm above the anal verge, where 21 anastomoses were constructed with <br>
traditional circular staplers and 27 with the C-REX LapAid device. <br>
Bursting pressure was measured at different time intervals <br>
postoperatively through an attached anal plug while the upper limit of <br>
the bowel segment was closed with a bowel clamp. Early histological <br>
changeswere assessed 6-24 h after the anastomotic formation with <br>
vascular CD31 and collagen Masson Trichrom staining. Results: All <br>
animals recovered uneventfully after the surgical procedure. The <br>
circular stapled anastomoses exhibited a median bursting pressure of 36 <br>
mbar (28-64) at 1 h, 45 mbar (43-69) at 6 h, and 145 mbar (85-185) 12 h <br>
after surgery. In comparison, the C-REX LapAid anastomoses demonstrated a<br>
median bursting pressure of 195 mbar (180-240) at 1 h, 192 mbar <br>
(180-220) at 6 h, and 180 mbar (160-180) 12 h after surgery, <br>
representing a 2-5-fold higher median bursting pressure in the early <br>
anastomotic healing phase. Early microscopic architecture showed little <br>
evidence of vascular and collagen formation. Conclusion: The novel C-REX<br>
LapAid device demonstrated significantly higher bursting pressure <br>
values in the early phase of the anastomotic healing process compared to<br>
the circular stapled method. A clinical study to further verify the <br>
benefitsofC-REXLapAid iswarranted. <br/></p>}},
author = {{Vilhjalmsson, Dadi Thor and Grönberg, Anders and Syk, Ingvar and Thorlacius, Henrik Tobias}},
issn = {{0014-312X}},
keywords = {{Anastomotic leakage; C-REX; CARP; Compression anastomosis; LapAid; RectoAid}},
language = {{eng}},
number = {{1}},
pages = {{9--17}},
publisher = {{Karger}},
series = {{European Surgical Research}},
title = {{Comparison of the C-REX LapAid and Circular Stapled Colorectal Anastomoses in an Experimental Model}},
url = {{http://dx.doi.org/10.1159/000543069}},
doi = {{10.1159/000543069}},
volume = {{66}},
year = {{2025}},
}