Primary repair of esophageal atresia Gross type C via thoracoscopic magnetic compression anastomosis:Is it the best option?

Magnetic compression anastomosis is a promising treatment option for patients with complex esophageal atresia;but,at the present time,should not be the first therapeutic option in those cases where the surgeon can perform a primary anastomosis of the two ends of the esophagus with acceptable tension.

Influence of different magnetic forces on the effect of colonic anastomosis in rats

BACKGROUND Despite much work having been conducted on magnetic compression anastomo-sis(MCA)in the digestive tract,there are no reports on the influence of magnetic force on the anastomosis.AIM To investigate the effect of different magnetic force magnets on the MCA of the digestive tract.METHODS Two groups of magnets of the same sizes but different magnetic forces were designed and produced.A total of 24 Sprague-Dawley rats were randomly assigned into two groups(powerful magnet group and common magnet group),with 12 rats in each group.Two types of magnets were used to complete the colonic side-to-side anastomosis of the rats.The operation time and magnet discharge time were recorded.The anastomotic specimens were obtained 4 wk after the operation and then the burst pressure and diameter of the anastomosis were measured,and the anastomosis was observed via the naked eye and subjected to histological examination.RESULTS The magnetic forces of the powerful and common magnet groups at zero distance were 8.26 N and 4.10 N,respectively.The colonic side-to-side anastomosis was completed in all 24 rats,and the operation success rate and postoperative survival rate were 100%.No significant difference was noted in the operation time between the two groups.The magnet discharge time of the powerful magnet group was slightly longer than that of the common magnet group,but the difference was not statistically significant(P=0.513).Furthermore,there was no statistical difference in the burst pressure(P=0.266)or diameter of magnetic anastomosis(P=0.095)between the two groups.The gross specimens of the two groups showed good anastomotic healing,and histological observation indicated good mucosal continuity without differences on healing.CONCLUSION In the rat colonic side-to-side MCA model,both the powerful magnet with 8.26 N and the common magnet with 4.10 N showed no significant impact on the anastomosis establishment process or its effect.

Magnetic compression anastomosis to restore biliary tract continuity after obstruction following major abdominal trauma:A case report

BACKGROUND The combination of magnetic compression anastomosis(MCA)and endoscopy has been used to treat biliary stricture after liver transplantation.However,its use for the treatment of complex biliary obstruction after major abdominal trauma has not been reported.This case report describes the successful use of MCA for the treatment of biliary obstruction resulting from major abdominal trauma.A 23-year-old man underwent major abdominal surgery(repair of liver rupture,right half colon resection,and ileostomy)following a car accident one year ago.The abdominal drainage tube,positioned at the Winslow foramen,was draining approximately 600-800 mL of bile per day.During the two endoscopic retrograde cholangiopancreatography procedures,the guide wire was unable to enter the common bile duct,which prevented placement of a biliary stent.MCA combined with endoscopy was used to successfully achieve magnetic anastomosis of the peritoneal sinus tract and duodenum,and then a choledochoduodenal stent was placed.Finally,the external biliary drainage tube was removed.The patient achieved internal biliary drainage leading to the removal of the external biliary drainage tube,which improved the quality of life.CONCLUSION Magnetic compression technique can be used for the treatment of complex biliary obstruction with minimal operative trauma.

Magnetic compression anastomosis for reconstruction of digestive tract after total gastrectomy in beagle model

BACKGROUND Magnetic compression anastomosis(MCA)is a simple procedure contributing to a reliable anastomosis.However,digestive-tract reconstruction after total gastrectomy using MCA has not yet been reported.AIM To investigate the feasibility of MCA for simultaneous esophagojejunostomy and jejunojejunostomy after total gastrectomy using beagle dogs.METHODS Sixteen beagles were randomly divided into an MCA group(study group,n=8)and a manual-suture anastomosis group(control group,n=8).Two different magnetic anastomosis devices were used in the study group for esophagojejunal and jejunojejunal anastomoses.Both devices included a pair of circular daughter and parent magnets each.The time of esophagojejunostomy and jejunojejunostomy,postoperative complications,and survival rate of the two groups were compared.The dogs were sacrificed one month after the operation and their anastomotic specimens were obtained.Healing was observed by the naked eye and a light microscope.RESULTS Digestive-tract reconstruction after total gastrectomy was successfully completed in both groups(survival rate=100%).In the study group,esophagojejunal and jejunojejunal anastomoses took 6.13±0.58 and 4.06±0.42 min,respectively,significantly lower than those in the control group(15.63±1.53 min,P<0.001 and 10.31±1.07 min,P<0.001,respectively).Complications such as bleeding,anastomotic leakage,and anastomotic stenosis were not observed.In the study group,the magnets did not interfere with each other.Discharge time of the jejunojejunal magnetic anastomosis device was 10.75±1.28 d,while that of the esophagojejunal magnetic anastomosis device was 12.25±1.49 d.Residual silk was found in the control group.The study group showed a greater smoothness of the anastomosis than that of the control group.All layers of anastomosis healed well in both groups.CONCLUSION MCA is a safe and feasible procedure for digestive-tract reconstruction after total gastrectomy in this animal model.

Primary repair of esophageal atresia gross type C via thoracoscopic magnetic compression anastomosis:A case report

BACKGROUND Esophageal atresia(EA)is a life-threatening congenital malformation in newborns,and the traditional repair approaches pose technical challenges and are extremely invasive.Therefore,surgeons have been actively investigating new minimally invasive techniques to address this issue.Magnetic compression anastomosis has been reported in several studies for its potential in repairing EA.In this paper,the primary repair of EA with magnetic compression anastomosis under thoracoscopy was reported.CASE SUMMARY A full-term male weighing 3500 g was diagnosed with EA gross type C.The magnetic devices used in this procedure consisted of two magnetic rings and several catheters.Tracheoesophageal fistula ligation and two purse strings were performed.The magnetic compression anastomosis was then completed thoracoscopically.After the primary repair,no additional operation was conducted.A patent anastomosis was observed on the 15th day postoperatively,and the magnets were removed on the 23rd day.No leakage existed when the transoral feeding started.CONCLUSION Thoracoscopic magnetic compression anastomosis may be a promising minimally invasive approach for repairing EA.

Magnetic compression anastomosis for sigmoid stenosis treatment:A case report

BACKGROUND Endoscopic balloon dilation is a minimally invasive treatment for colorectal stenosis.Magnetic compression anastomosis can be applied against gastrointestinal anastomosis.When combined with endoscopy,it offers a unique approach to the recanalization of colorectal stenosis.CASE SUMMARY We have reported here the case of a 53-year-old female patient who underwent a descending colostomy due to sigmoid obstruction.Postoperative fistula restoration was not possible in her due to sigmoid stenosis.Accordingly,endoscopicassisted magnetic compression anastomosis for sigmoid stenosis was performed,and the sigmoid stenosis was recanalized 15 d after the surgery.Subsequently,a reduction colostomy was successfully performed after 10 d.CONCLUSION This case report proposes a novel minimally invasive treatment approach for colorectal stenosis.

Healing of Stoma After Magnetic Biliary-Enteric Anastomosis in Canine Peritonitis Models

Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis model in mongrel dogs(n=32). Magnetic anastomosis(group A, n=16) and traditional suture anastomosis(group B, n=16) were performed to reconstruct the biliary-enteric continuity in one stage. Half of the dogs in each group were euthanized on the 30 th postoperative day, and the other half on the 90 th postoperative day to harvest the stoma region. The healing conditions of the stoma after the 2 anastomotic approaches were observed with naked eyes, under light microscope and scanning electron microscope. Results The stoma leakage rate(50% versus 0% on the 30 th postoperative day, 37.5% versus 12.5% on the 90 th postoperative day, both P<0.05) and stenosis degree(13.9%±0.3% versus 7.1%±0.3% on the 30 th postoperative day, 17.2%±0.4% versus 9.4%±0.4% on the 90 th postoperative day, both P<0.01) were significantly higher in group B than in group A. Compared with traditional manual anastomoses, the histological analysis under light and electron microscope showed a more continuous stoma with more regular epithelium proliferation and collagen arrangement, less inflammation in group A. Conclusions Magnetic anastomosis stent ensures better healing of the stoma even under the circumstance of severe inflammation.

Sutureless Intestinal Anastomosis with a Novel Device of Magnetic Compression Anastomosis

Objective To explore the feasibility and efficiency of a novel magnetic compression anastomats(MCAs) in intestinal anastomosis.Methods A total of 36 male mongrel canines underwent intestinal anastomosis using traditional hand-sewn(n=18) or a novel MCAs(n=18).We compared the anastomosis time,postoperative complications,bursting strength of anastomoses,gross appearance,and pathology between two groups at each time-point of follow-up.Results The mean anastomosis time with MCAs was significantly less than that with hand-sewn(8.50±1.95 vs.31.1±4.32 minutes,P<0.001).The blood stools and intussusceptions occurred in both groups during follow-up period.Only 1 mongrel canine receiving intestinal anastomosis by MCAs experienced anastomotic leakage.The average bursting pressure of anastomoses obtained from mongrel canines undergoing intestinal anastomosis by MCAs was significantly higher than that by traditional hand-sewn at 1 week's follow-up time(P<0.05).Gross appearance of the anastomoses constructed by MCAs was relatively smoother and flatter.Pathological evalution of anastomoses revealed that general inflammation was greater in hand-sewn anastomoses than magnetic anastomosis.Conclusion The magnetic compression anastomat is a safe and effective device of sutureless intestinal anastomosis in canine models.

Fedora-type magnetic compression anastomosis device for intestinal anastomosis

BACKGROUND Although previous studies have confirmed the feasibility of magnetic compression anastomosis(MCA),there is still a risk of long-term anastomotic stenosis.For traditional MCA devices,a large device is associated with great pressure,and eventually increased leakage.AIM To develop a novel MCA device to simultaneously meet the requirements of pressure and size.METHODS Traditional nummular MCA devices of all possible sizes were used to conduct ileac anastomosis in rats.The mean(±SD)circumference of the ileum was 13.34±0.12 mm.Based on short-and long-term follow-up results,we determined the appropriate pressure range and minimum size.Thereafter,we introduced a novel“fedora-type”MCA device,which entailed the use of a nummular magnet with a larger sheet metal.RESULTS With traditional MCA devices,the anastomoses experienced stenosis and even closure during the long-term follow-up when the anastomat was smaller thanΦ5 mm.However,the risk of leakage increased when it was larger thanΦ4 mm.On comparison of the different designs,it was found that the“fedora-type”MCA device should be composed of aΦ4-mm nummular magnet with aΦ6-mm sheet metal.CONCLUSION The diameter of the MCA device should be greater than 120%of the enteric diameter.The novel“fedora-type”MCA device controls the pressure and optimizes the size.

Techniques for colorectal anastomosis

Colorectal anastomotic leak remains one of the most feared post-operative complications, particularly after anterior resection of the rectum with, the shift from abdomino-peritoneal resections to total mesorectal excision and primary anastomosis. The literature fails to demonstrate superiority of stapled over hand-sewn techniques in colorectal anastomosis, regardless of the level of anastomosis, although a high stricture rate was noted in the former technique. Thus, improvements in safety aspects of anastomosis and alternatives to handsewn and stapled techniques are being sought. Here, we review alternative anastomotic techniques used to fashion bowel anastomosis. Compression anastomosis using compression anastomotic clips, endoluminal compression anastomotic rings, AKA-2, biofragmental anastomotic rings, or Magnamosis all involve the concept of creating a sutureless end-to-end anastomosis by compressing two bowel ends together, leading to a simultaneous necrosis and healing process that joins the two lumens. Staple line reinforcement is a new approach that reduce the drawbacks of staplers used in colorectal practice, i.e. leakage, bleeding, misfi ring, and inadequate tissue approximation. Various nonabsorbable, semi or fully absorbable materials are now available. Two other techniques can provide alternative anastomotic support to the suture line: a colorectal drain and a polyester stent, which can be utilized in ultra-low rectal excision and can negate the formation of a defunctioning stoma. Doxycycline coated sutures have been used to overcome the post-operative weakness in anastomosis secondary to rapid matrix degradation mediated by matrix metalloproteinase. Another novel technique, the electric welding system, showed promising results in construction of a safe, neat, smooth sutureless bowel anastomosis. Various anastomotic techniques have been shown to be comparable to the standard techniques of suturing and stapling. However, most of these alternatives need to be accepted and optimized for future use.

Fast magnetic reconstruction of the portal vein with allogeneic blood vessels in canines

BACKGROUND： The resection and reconstruction of large vessels, including the portal vein, are frequently needed in tumor resection. Warm ischemia before reconstruction might have deleterious effects on the function of some vital organs and therefore, how to reconstruct the vessels quickly after resection is extremely important. The present study was to introduce a new type of magnetic compression anastomosis （MCA） device to establish a quick non-suture anastomosis of the portal vein after resection in canines.

Combined endoscopy/laparoscopy/percutaneous transhepatic biliary drainage, hybrid techniques in gastrointestinal and biliary diseases

In recent years,a wide range of gastrointestinal endoscopy techniques have been developed,such as endoscopic submucosal dissection(ESD)and endoscopic retrograde cholangiopancreatography(ERCP).Although ESD and ERCP have an important role in gastrointestinal and biliary diseases,each technique has its limitations.Hybrid techniques that combine endoscopic and surgical procedures have emerged that have the advantages of different procedures and negate their limitations at the same time.Laparoscopic endoscopic cooperative surgery and modified laparoscopic endoscopic cooperative surgery combine ESD and laparoscopic techniques to resect submucosal tumors with minimum resection area.Air leak test by intraoperative endoscopy can effectively identify a mechanically insufficient anastomosis and decrease the complication rate.The rendezvous technique that combines percutaneous transhepatic biliary drainage and endoscopy can be performed as a rescue approach for the treatment of biliary obstruction,stenosis and bile duct injuries.For patients with simultaneous presence of stones in the gallbladder and the common bile duct,the laparoendoscopic rendezvous technique can perform ERCP and laparoscopic cholecystectomy at the same time and reduces the risk of pancreatic injury caused by ERCP.Biliobiliary and bilioenteric anastomosis using magnetic compression anastomosis is another choice for biliary obstruction.The most common used approach to deliver the magnets is by percutaneous-peroral tract.Laparoscopicassisted ERCP is a safe and highly effective therapy for patients who develop biliary diseases after Roux-en-Y gastric bypass surgery.