***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Compression anastomotic ring-locking procedure ( CARP ) is a novel procedure for creating colonic anastomoses . The surgical procedure allows perioperative quantification of the compression pressure between the intestinal ends within the anastomosis and postoperative monitoring of the anastomotic integrity . We have recently shown that CARP is a safe and effective method for colonic anastomoses in pigs , and the purpose of the present study was to evaluate CARP for colonic anastomoses in humans . Material s and methods This is a prospect i ve study on 25 patients undergoing elective left-sided colonic resection .  Time for evacuation of the anastomotic rings , perioperative compression pressure , and adverse effects were recorded . Postoperative blood sample s were collected daily , and flexible sigmoidoscopy was performed 8–12 weeks after surgery to examine the anastomoses . Results Fourteen out of 25 patients underwent CARP . CARP  was not used in 11 patients due to advanced tumor disease ( two cases ) and size restrictions ( nine cases ) . No case of anastomotic leakage , bowel obstruction , or stenosis formation was observed . No device-related perioperative adverse events were noted . The surgical device evacuated spontaneously in all patients by the natural route after a median of 10 days . Perioperative compression pressure ranged between 85 and 280 mBar ( median 130 mBar ) . Flexible sigmoidoscopy revealed smooth anastomoses without signs of pathological inflammation or stenosis in all cases . Conclusion Our results indicate that the novel suture-less CARP is a safe and effective method for creating colonic anastomoses . Further studies are warranted in larger patient population s to compare CARP head-on-head with stapled and /or h and -sewn colonic anastomoses The purpose of this study was to determine whether the characteristics of compression anastomoses created by a new device are comparable to existing stapler technology . A total of 18 pigs were studied , and each served as its own control using a 27-mm compression device and a 29-mm stapler . Anastomoses were r and omized to proximal and distal positions along the rectum and were separated by 10 cm . Six nonsurvival pigs were sacrificed at zero time to failure test the anastomoses . Twelve pigs were sacrificed at 14 days . Failure pressures , circumferences , and radiographic leak rates were determined . Anastomotic tissue was processed for matrix metalloproteinase , collagen , and elastin levels . The compression anastomoses had higher mean failure pressures than stapled anastomoses at zero time ( 103 vs 29.9 mm Hg ) . At 2 weeks , there was no difference between failure pressures ( 256 vs 250 mm Hg ) . During burst testing , 3 of the compression anastomoses failed at the anastomosis at 2 weeks , whereas none of the stapled anastomoses failed . The mean anastomotic circumference of the  compression anastomoses  was narrower than the stapled anastomoses ( 9.63 vs 11.25 cm , P = .001 ) . There were no clinical leaks or radiographic leaks by barium enema at 2 weeks . There was no difference between matrix metalloproteinase , collagen , or elastin content based on tissue analysis . There were dense adhesions to 7 of 12 ( 58.3 % ) of the stapled anastomoses , whereas only 1 of 12 ( 8.3 % ) of the compression anastomoses had flimsy adhesions . A new compression anastomosis technique using a nickel-titanium alloy may be an advance in technology by reducing leaks and eliminating foreign material in the anastomosis CONTEXT Selective reporting of outcomes within published studies based on the nature or direction of their results has been widely suspected , but direct evidence of such bias is currently limited to case reports . OBJECTIVE To study empirically the extent and nature of outcome reporting bias in a cohort of r and omized trials . DESIGN Cohort study using protocol s and published reports of r and omized trials approved by the Scientific-Ethical Committees for Copenhagen and Frederiksberg , Denmark , in 1994 - 1995 . The number and characteristics of reported and unreported trial outcomes were recorded from protocol s , journal articles , and a survey of trialists . An outcome was considered incompletely reported if insufficient data were presented in the published articles for meta- analysis . Odds ratios relating the completeness of outcome reporting to statistical significance were calculated for each trial and then pooled to provide an overall estimate of bias . Protocol s and published articles were also compared to identify discrepancies in primary outcomes . MAIN OUTCOME MEASURES Completeness of reporting of efficacy and harm outcomes and of statistically significant vs nonsignificant outcomes ; consistency between primary outcomes defined in the most recent protocol s and those defined in published articles . RESULTS One hundred two trials with 122 published journal articles and 3736 outcomes were identified . Overall , 50 % of efficacy and 65 % of harm outcomes per trial were incompletely reported . Statistically significant outcomes had a higher odds of being fully reported compared with nonsignificant outcomes for both efficacy ( pooled odds ratio , 2.4 ; 95 % confidence interval [ CI ] , 1.4 - 4.0 ) and harm ( pooled odds ratio , 4.7 ; 95 % CI , 1.8 - 12.0 ) data . In comparing published articles with protocol s , 62 % of trials had at least 1 primary outcome that was changed , introduced , or omitted . Eighty-six percent of survey responders ( 42/49 ) denied the existence of unreported outcomes despite clear evidence to the contrary . CONCLUSIONS The reporting of trial outcomes is not only frequently incomplete but also biased and inconsistent with protocol s. Published articles , as well as review s that incorporate them , may therefore be unreliable and overestimate the benefits of an intervention . To ensure transparency , planned trials should be registered and protocol s should be made publicly available prior to trial completion Background Shape-memory compression bowel anastomosis using a nickel and titanium alloy may reduce leak rates and eliminate foreign anastomotic material . Its safety and efficacy had been demonstrated by animal studies . We conducted the first prospect i ve multi-center clinical evaluation of the safety and effectiveness of BioDynamix anastomosis with ColonRing ™ for large-bowel end-to-end or side-to-end anastomosis . Material s and methods The ColonRing ™ was compared to the st and ard double-stapled colorectal/colocolonic anastomosis . Intraoperative and immediate postoperative and 1- and 3-month postoperative follow-up data were recorded . Results Ten study patients ( four males , median age 62 years , range 35–75 ) were compared to 13 demographically matched controls ( six males , median age 62 years , range 47–82 ) . Colorectal neoplasia was the most frequent indication for surgery ( 21/23 patients , 91 % ) . The median anastomotic distance from the anal verge for both groups was 10 cm ( 6–20 cm ) . The first postoperative bowel movement was on day 5 ±2.2 ( study group ) and on day 4 ±1.8 ( controls ) , and the median hospital stay was 8 days ( 6–14 days ) and 7 days ( 6–13 days ) , respectively . There were no anastomotic leaks . There were three minor complications in each group , unrelated to the device in the study group . Two patients required transanal digital extraction of the ring which was detached but not expelled ( one had a soft anastomotic stricture ) . Conclusions Our preliminary results in this first study on humans indicate that the safety and efficacy of BioDynamix anastomosis with ColonRing ™ in colorectal anastomosis in human is comparable to st and ard staples technology and warrant larger studies for further validation The recent development of a compression device using shape memory Nitinol technogy to create an end‐to‐end anastomosis has renewed the interest in sutureless anastomotic techniques . A phase II , prospect i ve open label clinical trial was started in May 2007 to evaluate the feasibility and safety of this new anastomotic device .  Fourty patients who need left colectomy or high anterior resection for either diverticular disease or adenocarcinoma will be recruited in two academic hospitals ( Uppsala , Sweden and Leuven , Belgium ) .  Clinical leakage is the primary endpoint . Only preliminary results are available to date as the recruitment is ongoing . The median age of the first ten patients is 57.5 years ( 44–72 ) .  No anastomotic leakage occurred . The median hospital stay was 4.0 days . Only three patients noticed the passage of the ring through the anal canal . By three weeks no ring was sustained in the gastrointestinal tract as was objectified by plain X‐ray . First clinical use of this new anastomotic device seems promising . Final results for the total phase II trial are awaited . A prospect i ve r and omized trial to compare the efficacy of the EndoCar 28 with conventional stapling  should be the next step Purpose The present study was performed to get a better insight in the incidence of anastomotic leakage leading to reintervention when using the C-seal : a biodegradable sheath that protects the stapled colorectal anastomosis from leakage . Methods The C-seal is a thin walled tube-like sheath that forms a protective sheath within the bowel lumen . Thirty-seven patients undergoing surgery with creation of a stapled colorectal anastomosis with C-seal were analyzed . Follow-up was completed until 3 months after surgery . Results One patient ( 3 % ) developed anastomotic leakage leading to reintervention . None of the 37 anastomoses was dismantled . One patient was diagnosed with a  rectovaginal fistula .  In three patients ( 8 % ) , a perianastomotic abscess spontaneously drained . Conclusion The incidence of anastomotic leakage leading to reintervention when using the C-seal ( 3 % ) is lower than expected based on the literature ( 11 % ) . We have currently set-up a multicenter r and omized trial to confirm the efficiency of the C-seal ( www.csealtrial.nl ) Objective : The purpose of this study was to identify patient , clinical , and surgical factors that may predispose patients to anastomotic leak ( AL ) after large bowel surgery . Background : Anastomotic leak is still one of the most devastating complications following colorectal surgery . Knowledge about factors predisposing patients to AL is vital to its early detection , decision making for surgical time , managing preoperative risk factors , and postoperative complications . Methods : This was a prospect i ve observational , quality improvement study in a cohort of 616 patients undergoing colorectal resection in a single institution with the main outcome being AL within 30 days postoperatively . Some of the predictor variables were age , sex , Charlson Comorbidity Index ( CCI ) , radiation and chemotherapy , immunomodulator medications , albumin , preoperative diagnoses , surgical procedure(s ) , surgical technique ( laparoscopic vs open ) , anastomotic technique ( staple vs h and sewn ) , number of major arteries ligated at surgery , surgeon 's experience , presence of infectious condition at surgery , intraoperative adverse events , and functional status using 36-Item Short Form General Health Survey . Results : Of the 616 patients , 53.4 % were female . The median age of the patients was 63 years and the mean body mass index was 25.9 kg/m2 . Of them , 80.3 % patients had laparoscopic surgery and 19.5 % had open surgery .  AL occurred in 5.7 % ( 35 ) patients . In multivariate analysis , significant independent predictors for leak were anastomoses less than 10 cm from the anal verge , CCI of 3 or more , high inferior mesenteric artery ligation ( above left colic artery ) , intraoperative complications , and being of the male sex . Conclusions : Multiple risk factors exist that predispose patients to ALs . These risk factors should be considered before and during the surgical care of colorectal patients Objective To analyze total mesorectal excision ( TME ) for rectal cancer by the laparoscopic approach during a prospect i ve nonr and omized trial . Summary Background Data Improved local control and survival rates in the treatment of rectal cancer have been reported after TME . Methods The authors conducted a prospect i ve consecutive series of 100 laparoscopic TMEs for low and mid-rectal tumors . All patients had a sphincter-saving procedure . Case selection , surgical technique , and clinical and oncologic results were review ed . Results The distal limit of rectal neoplasm was on average 6.1 ( range 3–12 ) cm from the anal verge . The mean operative time was 250 ( range 110–540 ) minutes . The conversion rate was 12 % . Excluding the patient who stayed 104 days after a severe fistula and reoperation , the mean postoperative stay was 12.05 ( range 5–53 ) days . The 30-day mortality was 2 % and the overall postoperative morbidity was 36 % , including 17 anastomotic leaks . Of 87 malignant cases , 70 ( 80.4 % ) had a minimum follow-up of 12 months , with a median follow-up of 45.7 ( range 12–72 ) months . During this period 18.5 % ( 13/70 ) died of cancer and 8.5 % ( 6/70 ) are alive with metastatic disease . The port-site metastasis rate was 1.4 % ( 1/70 ) : a rectal cancer 
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There were no statistically significant differences  between compression and conventional anastomoses in any of the secondary outcomes .
This review was unable to demonstrate any statistically significant differences in favor of the compression anastomosis technique over conventional manual or stapled mechanical anastomoses