Transanal formation of anastomosis using C-REX device is safe and effective in high anterior resection

Purpose C-REX is a novel instrument for creating stapleless colorectal anastomosis by compression. The aim of this study was to evaluate the safety and effectiveness of C-REX in open- and laparoscopic high anterior resections. Methods A prospective clinical study on 21 patients reconstructed with C-REX colorectal anastomosis following high anterior resection of the sigmoid colon using intraabdominal (n = 6) or transanal (n = 15) C-REX instruments for placement of the anastomotic rings. Any signs of complication were prospectively monitored by a predefined protocol. Anastomotic Contact Pressure (ACP) was measured via a catheter-based system and time for evacuation of the anastomotic rings by the natural route was noted. Blood samples were collected daily and flexible sigmoidoscopy was performed postoperatively to examine macroscopic appearance of the anastomoses. Results One patient operated with the intraabdominal anastomosis technique with an ACP of 50 mBar had to be reoperated because of anastomotic leakage. None of the 15 patients operated with the transanal technique had anastomotic complications and their ACP ranged between 145–300 mBar. C-REX rings were uneventfully expelled by the natural route in all patients after a median of 10 days. Flexible sigmoidoscopy showed well-healed anastomoses without stenosis in 17 patients and a moderate subclinical stricture in one patient. Conclusion These results indicate that the novel transanal C-REX device is a safe and effective method for colorectal anastomosis following high anterior resections, irrespective of open or laparoscopic approach. Moreover, C-REX allows measurement of intraoperative ACP and thereby a quantitative evaluation of the anastomotic integrity.