BACKGROUND The nickel-titanium compression anastomosis ring device (ColonRing, NiTi Surgical Solutions, Netanya, Israel) has been cleared by the Food and Drug Administration in 2006 to construct gastrointestinal anastomoses. We evaluated the anastomotic leak rate after end-to-end anastomosis using the ColonRing device. METHODS Using a multinational (16 countries), multicenter (178 centers) data registry provided by NiTi Surgical Solutions, Netanya, Israel, we retrospectively examined clinical data of patients who underwent elective laparoscopic or open left-sided colectomy and anterior resection from January 2008 to June 2010. RESULTS A total of 1,180 patients underwent end-to-end anastomosis using the ColonRing device during the study period. The overall anastomotic leak rate was 3.22% (38 patients). The median length of hospital stay was 6 days (range 2 to 21 days). The median ring expulsion time was 8 days. The earliest ring expulsion time was 6 days; however, in 1 patient, the ring did not expel. In 4 patients, the anastomosis had to be immediately recreated because of 1 misfiring and 3 incomplete anastomoses. CONCLUSIONS The use of the ColonRing device is feasible and safe and could be considered an alternative technology for end-to-end colorectal anastomosis.