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Zhang G, Liang Z, Zhao G, Zhang S. Endoscopic application of magnetic compression anastomosis: a review. J Gastroenterol Hepatol 2024; 39:1256-1266. [PMID: 38638082 DOI: 10.1111/jgh.16574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
Magnetic compression anastomosis (MCA) is a new method that provides sutureless passage construction for tubular organs. Due to the high recurrence rate of conventional endoscopic treatment and the high morbidity and mortality of surgical procedures, the MCA technique shows promise. The aim of this review is to comprehensively examine the literature related to the use of MCA in different gastrointestinal diseases over the past few years, categorizing them according to the anastomotic site and describing in detail the various methods of magnet delivery and the clinical outcomes of MCA. MCA is an innovative technique, and its use represents an advancement in the field of minimally invasive interventions. Comparison studies have shown that the anastomosis formed by MCA is comparable to or better than surgical sutures in terms of general appearance and histology. Although most of the current research has involved animal studies or studies with small populations, the safety and feasibility of MCA have been preliminarily demonstrated. Large prospective studies involving populations are still needed to guarantee the security of MCA. For technologies that have been initially used in clinical settings, effective measures should also be implemented to identify, even prevent, complications. Furthermore, specific commercial magnets must be created and optimized in this emerging area.
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Affiliation(s)
- Guo Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Liang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guiping Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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2
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Jang SI, Do MY, Lee SY, Cho JH, Joo SM, Lee KH, Chung MJ, Lee DK. Magnetic compression anastomosis for the treatment of complete biliary obstruction after cholecystectomy. Gastrointest Endosc 2024:S0016-5107(24)03206-1. [PMID: 38762041 DOI: 10.1016/j.gie.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/02/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND AND AIMS Post-cholecystectomy biliary strictures can be treated surgically or nonsurgically. Although endoscopic or percutaneous treatments are the preferred approaches, these methods are not feasible in cases in which complete stricture occlusion prevents the successful passage of a guidewire. The utility of magnetic compression anastomosis (MCA) in patients with post-cholecystectomy complete biliary obstruction that cannot be treated conventionally was evaluated. METHODS MCA was performed in 10 patients with post-cholecystectomy biliary strictures that did not resolve with conventional endoscopic or percutaneous treatment. One magnet was delivered through the percutaneous transhepatic biliary drainage tract, and another was advanced via ERCP of the common bile duct. After magnet approximation and recanalization, a fully covered self-expandable metal stent (FCSEMS) was placed for 3 months and then replaced for an additional 3 months. Stricture resolution was evaluated after FCSEMS removal. RESULTS Among the 10 patients who underwent MCA for post-cholecystectomy biliary stricture, the biliary injury was Strasberg type B in 2, type C in 3, and type E in 5. Recanalization was successful in all patients (technical success rate, 100%). The mean follow-up period after recanalization was 50.2 months (range, 13.2-116.8 months). Partial restenosis after MCA occurred in 2 patients at 24.1 and 1.6 months after stent removal. ERCP with FCSEMS placement resolved the recurrent stenosis in both patients. CONCLUSIONS MCA is a useful nonsurgical alternative treatment for complete biliary obstruction after cholecystectomy that cannot be resolved by use of conventional methods.
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Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Young Do
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Medicine, Graduate School of Yonsei University College of Medicine, Seoul, Republic of Korea
| | - See Young Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Hee Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Moon Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Hun Lee
- Department of Radiology, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Moon Jae Chung
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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3
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Liu P, Liu X, Yang L, Qian Y, Lu Q, Shi A, Wei S, Zhang X, Lv Y, Xiang J. Enhanced hemocompatibility and rapid magnetic anastomosis of electrospun small-diameter artificial vascular grafts. Front Bioeng Biotechnol 2024; 12:1331078. [PMID: 38328445 PMCID: PMC10847591 DOI: 10.3389/fbioe.2024.1331078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
Background: Small-diameter (<6 mm) artificial vascular grafts (AVGs) are urgently required in vessel reconstructive surgery but constrained by suboptimal hemocompatibility and the complexity of anastomotic procedures. This study introduces coaxial electrospinning and magnetic anastomosis techniques to improve graft performance. Methods: Bilayer poly(lactide-co-caprolactone) (PLCL) grafts were fabricated by coaxial electrospinning to encapsulate heparin in the inner layer for anticoagulation. Magnetic rings were embedded at both ends of the nanofiber conduit to construct a magnetic anastomosis small-diameter AVG. Material properties were characterized by micromorphology, fourier transform infrared (FTIR) spectra, mechanical tests, in vitro heparin release and hemocompatibility. In vivo performance was evaluated in a rabbit model of inferior vena cava replacement. Results: Coaxial electrospinning produced PLCL/heparin grafts with sustained heparin release, lower platelet adhesion, prolonged clotting times, higher Young's modulus and tensile strength versus PLCL grafts. Magnetic anastomosis was significantly faster than suturing (3.65 ± 0.83 vs. 20.32 ± 3.45 min, p < 0.001) and with higher success rate (100% vs. 80%). Furthermore, magnetic AVG had higher short-term patency (2 days: 100% vs. 60%; 7 days: 40% vs. 0%) but similar long-term occlusion as sutured grafts. Conclusion: Coaxial electrospinning improved hemocompatibility and magnetic anastomosis enhanced implantability of small-diameter AVG. Short-term patency was excellent, but further optimization of anticoagulation is needed for long-term patency. This combinatorial approach holds promise for vascular graft engineering.
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Affiliation(s)
- Peng Liu
- Center for Regenerative and Reconstructive Medicine, Med-X Institute, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xin Liu
- Department of Graduate School, Xi’an Medical University, Xi’an, Shaanxi, China
| | - Lifei Yang
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yerong Qian
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qiang Lu
- Department of Geriatric Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Aihua Shi
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Shasha Wei
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xufeng Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yi Lv
- Center for Regenerative and Reconstructive Medicine, Med-X Institute, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Junxi Xiang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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4
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Fass TH, Cahill R, Khan M, Hao G, Cantillon-Murphy P. Design and pre-clinical evaluation of a folding magnetic anastomosis device for minimally invasive surgery. MINIM INVASIV THER 2022; 31:1050-1057. [DOI: 10.1080/13645706.2022.2119417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- T. H. Fass
- School of Engineering and Architecture, University College Cork, Cork, Ireland
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Ronan Cahill
- Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Mohd Khan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Guangbo Hao
- School of Engineering and Architecture, University College Cork, Cork, Ireland
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Pádraig Cantillon-Murphy
- School of Engineering and Architecture, University College Cork, Cork, Ireland
- Tyndall National Institute, University College Cork, Cork, Ireland
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Schepis T, Boškoski I, Tringali A, Costamagna G. Role of ERCP in Benign Biliary Strictures. Gastrointest Endosc Clin N Am 2022; 32:455-475. [PMID: 35691691 DOI: 10.1016/j.giec.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Benign biliary strictures (BBS) can be associated with several causes, with postoperative and inflammatory strictures representing the most common ones. Endoscopy represents nowadays the first-line treatment in the management of BBS. Endoscopic balloon dilatation, plastic stents placement, fully covered metal stent placement, and magnetic compression anastomosis are the endoscopic techniques available for the treatment of BBS. The aim of this study is to perform a review of the literature to assess the role of endoscopy in the management of BBS and to evaluate the application of the different procedures in the different clinical settings.
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Affiliation(s)
- Tommaso Schepis
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica Del Sacro Cuore di Roma, Italy.
| | - Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica Del Sacro Cuore di Roma, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica Del Sacro Cuore di Roma, Italy
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Fang A, Kim IK, Ukeh I, Etezadi V, Kim HS. Percutaneous Management of Benign Biliary Strictures. Semin Intervent Radiol 2021; 38:291-299. [PMID: 34393339 DOI: 10.1055/s-0041-1731087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Benign biliary strictures are often due to a variety of etiologies, most of which are iatrogenic. Clinical presentation can vary from asymptomatic disease with elevated liver enzymes to obstructive jaundice and recurrent cholangitis. Diagnostic imaging methods, such as ultrasound, multidetector computed tomography, and magnetic resonance imaging (cholangiopancreatography), are used to identify stricture location, extent, and possible source of biliary obstruction. The management of benign biliary strictures requires a multidisciplinary team approach and include endoscopic, percutaneous, and surgical interventions. Percutaneous biliary interventions provide an alternative diagnostic and therapeutic approach, especially in patients who are not amenable to endoscopic evaluation. This review provides an overview of benign biliary strictures and percutaneous management by interventional radiologists. Diagnostic evaluation with percutaneous transhepatic cholangiography and treatment options, including biliary drainage, balloon dilation, retrievable/biodegradable stents, and other innovative minimally invasive options, are discussed.
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Affiliation(s)
- Adam Fang
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Il Kyoon Kim
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ifechi Ukeh
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hyun S Kim
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Sritunyarat Y, Ratanachu-Ek T, Attasaranya S, Ridtitid W, Rerknimitr R. Magnetic compression anastomosis via EUS-guided hepaticogastrostomy for recanalization of complete common hepatic bile duct transection. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2021; 6:365-367. [PMID: 34401633 PMCID: PMC8353199 DOI: 10.1016/j.vgie.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Magnetic compression anastomosis via EUS-guided hepaticogastrostomy for recanalization of complete common hepatic bile duct transection.
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Affiliation(s)
- Yingluk Sritunyarat
- Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thawee Ratanachu-Ek
- Rajavithi Surgery Endoscopy Department, Faculty of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Siriboon Attasaranya
- Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Rajavithi Surgery Endoscopy Department, Faculty of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Wiriyaporn Ridtitid
- Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Gastrointestinal Endoscopy Excellence Center, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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8
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Li Y, Zhang N, Lv Y. Expert consensus on magnetic recanalization technique for biliary anastomotic strictures after liver transplantation. Hepatobiliary Surg Nutr 2021; 10:401-404. [PMID: 34159175 DOI: 10.21037/hbsn-20-800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yu Li
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, China.,Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, China
| | - Nan Zhang
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, China.,Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, China.,Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, China
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9
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Endoscopic gastrointestinal anastomosis: a review of established techniques. Gastrointest Endosc 2021; 93:34-46. [PMID: 32593687 DOI: 10.1016/j.gie.2020.06.057] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/11/2020] [Indexed: 02/08/2023]
Abstract
Technologic advancements in the field of therapeutic endoscopy have led to the development of minimally invasive techniques to create GI anastomosis without requiring surgery. Examples of the potential clinical applications include bypassing malignant and benign gastric outlet obstruction, providing access to the pancreatobiliary tree in those who have undergone Roux-en-Y gastric bypass, and relieving pancreatobiliary symptoms in afferent loop syndrome. Endoscopic GI anastomosis is less invasive and less expensive than surgical approaches, result in improved outcomes, and therefore are more appealing to patients and providers. The aim of this review is to present the evolution of luminal endoscopic gastroenteric and enteroenteric anastomosis dating back to the first compression devices and to describe the clinical techniques being used today, such as magnets, natural orifice transluminal endoscopic surgery, and EUS-guided techniques. Through continued innovation, endoscopic interventions will rise to the forefront of the therapeutic arsenal available for patients requiring GI anastomosis.
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10
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Biliary reconstruction and complications in living donor liver transplantation. Int J Surg 2020; 82S:138-144. [DOI: 10.1016/j.ijsu.2020.04.069] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022]
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Jang SI, Cho JH, Lee DK. Magnetic Compression Anastomosis for the Treatment of Post-Transplant Biliary Stricture. Clin Endosc 2020; 53:266-275. [PMID: 32506893 PMCID: PMC7280848 DOI: 10.5946/ce.2020.095] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023] Open
Abstract
A number of different conditions can lead to a bile duct stricture. These strictures are particularly common after biliary operations, including living-donor liver transplantation. Endoscopic and percutaneous methods have high success rates in treating benign biliary strictures. However, these conventional methods are difficult to manage when a guidewire cannot be passed through areas of severe stenosis or complete obstruction. Magnetic compression anastomosis has emerged as an alternative nonsurgical treatment method to avoid the mortality and morbidity risks of reoperation. The feasibility and safety of magnetic compression anastomosis have been reported in several experimental and clinical studies in patients with biliobiliary and bilioenteric strictures. Magnetic compression anastomosis is a minimally traumatic and highly effective procedure, and represents a new paradigm for benign biliary strictures that are difficult to treat with conventional methods.
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Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Han SJ, Jang SI, Yoo SH, Lee DK. A case with combined postoperative bile leakage and anastomotic stricture after liver transplantation treated with magnet compression anastomosis. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii190023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sang Jo Han
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hwan Yoo
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Wang HH, Ma J, Wang SP, Ma F, Lu JW, Xu XH, Lv Y, Yan XP. Magnetic Anastomosis Rings to Create Portacaval Shunt in a Canine Model of Portal Hypertension. J Gastrointest Surg 2019; 23:2184-2192. [PMID: 30132290 DOI: 10.1007/s11605-018-3888-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/15/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE This study evaluated a novel magnetic compression technique (magnamosis) for creating a portacaval shunt in a canine model of portal hypertension, relative to traditional manual suture. METHODS Portal hypertension was induced in 18 dogs by partial ligation of the portal vein (baseline). Six weeks later, extrahepatic portacaval shunt implantation was performed with either magnetic anastomosis rings, or traditional manual suture (n = 9, each). The two groups were compared for operative time, portal vein pressure, and serum biochemical indices. Twenty-four weeks post-implantation, the established anastomoses were evaluated by color Doppler imaging, venography, and gross and microscopic histological examinations. RESULTS Anastomotic leakage did not occur in either group. The operative time to complete the anastomosis for magnamosis (4.12 ± 1.04 min) was significantly less than that needed for manual suture (24.47 ± 4.89 min, P < 0.01). The portal vein pressure in the magnamosis group was more stable than that in the manual suture group. The blood ammonia level at the end of the 24-week post-implantation observation period was significantly lower in the magnamosis group than in the manual suture group. Gross and microscopic histological examinations revealed that better smoothness and continuity of the vascular intima had been achieved via magnamosis than with manual suture. CONCLUSION Magnamosis was superior to manual suture for the creation of a portacaval shunt in this canine model of portal hypertension.
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Affiliation(s)
- Hao-Hua Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, 710061, People's Republic of China
- Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, 710061, People's Republic of China
| | - Jia Ma
- Department of Surgical Oncology, The Third Affiliated Hospital of Xi'an Jiaotong University (Shaanxi Provincial People's Hospital), Xi'an, China
| | - Shan-Pei Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, 710061, People's Republic of China
- Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, 710061, People's Republic of China
| | - Feng Ma
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, 710061, People's Republic of China
- Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, 710061, People's Republic of China
| | - Jian-Wen Lu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, 710061, People's Republic of China
- Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, 710061, People's Republic of China
| | - Xiang-Hua Xu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, 710061, People's Republic of China
- Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, 710061, People's Republic of China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, 710061, People's Republic of China.
- Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, 710061, People's Republic of China.
| | - Xiao-Peng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an, 710061, People's Republic of China.
- Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an, 710061, People's Republic of China.
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14
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Zhao G, Ma J, Yan X, Li J, Ma F, Wang H, Liu Y, Lv Y. Optimized force range of magnetic compression anastomosis in dog intestinal tissue. J Pediatr Surg 2019; 54:2166-2171. [PMID: 30929946 DOI: 10.1016/j.jpedsurg.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/20/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Magnetic compression anastomosis (MCA) is a commonly used anastomosis method. MCA was widely used in tissues repair, gastroenterostomy, choledochoenterostomy, and so on. It is safer and more effective than stapler and manual surgical suturing. However, there are few detailed studies on the biomechanical characteristics and tissue transformation mechanisms of the anastomosis process. In this research, taking intestinal tissue as research object, we need to determine an optimal compressive force range to provide a biomechanical reference for the design of anastomats. METHODS Magnets with different magnetic force groups (2.06, 3.21, 6.27, 13.3 and 19.2 N) were implanted into each dog to form intestinal tissue side-to-side anastomoses. Five dogs were euthanized on each of postoperative day 1, day 3, and day 7. Anastomoses were then harvested and compared with respect to postoperative complications, histology and tear-resistance load capacity (TRLC). RESULTS The TRLC of anastomotic tissue formed by magnets with different magnetic forces differed markedly, but with the tissue growth, the TRLC differences between groups were decreased. Histology of anastomotic tissue showed that, in the initial stage, the anastomoses compressed by 2.06-N magnets did not form effectively, while the leakage appeared in the anastomoses compressed by 19.2-N magnets, in the rest groups, with magnetic force increasing, severity of ischemia and necrosis of compressed tissue increased and healing speed of anastomotic tissue improved. In the late stage, the influence of magnetic force for anastomotic tissue was gradually diminished. CONCLUSIONS The magnetic force applied on the magnetic compression anastomats affects the necrosis speed of compressed tissue and the healing speed of anastomotic tissue. The optimal compressive force range for intestinal compression anastomosis is 6.27 N to 13.3 N, and the actual optimal compression pressure is 79.8 kPa - 169 kPa. LEVEL OF EVIDENCE Magnetic compression anastomosis (MCA) is a commonly used anastomosis method. MCA was widely used in tissues repair, gastroenterostomy, choledochoenterostomy, and so on. It is safer and more effective than stapler and manual surgical suturing. However, there are few detailed studies on the biomechanical characteristics and tissue transformation mechanisms of the anastomosis process. In this research, taking intestinal tissue as research object, we need to determine an optimal compressive force range to provide a biomechanical reference for the design of anastomats.
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Affiliation(s)
- Guangbin Zhao
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, 710049, Xi'an, China.
| | - Jia Ma
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China; Department of surgical oncology, the Third Affiliated Hospital, Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, 710068, Xi'an, China.
| | - Xiaopeng Yan
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China
| | - Jianhui Li
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China; Department of surgical oncology, the Third Affiliated Hospital, Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, 710068, Xi'an, China
| | - Feng Ma
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China
| | - Haohua Wang
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China
| | - Yaxiong Liu
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, 710049, Xi'an, China.
| | - Yi Lv
- The First Affiliated Hospital of Xi'an Jiaotong University, 710061, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, 710061, Xi'an, China.
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15
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Gao Y, Wu RQ, Lv Y, Yan XP. Novel magnetic compression technique for establishment of a canine model of tracheoesophageal fistula. World J Gastroenterol 2019; 25:4213-4221. [PMID: 31435174 PMCID: PMC6700694 DOI: 10.3748/wjg.v25.i30.4213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clinically, tracheoesophageal fistula (TEF) is lack of effective surgical strategies. One reason is due to the lack of appropriate animal models of acquired TEF, which is usually complex and difficult. Recently, the magnetic compression technique has been applied for digestive tract anastomosis or vascular anastomosis in animals. In this study, an animal model of TEF in dogs was developed by using the magnetic compression technique, hoping to provide a new method for mimicking TEF.
AIM To establish a TEF model in dogs by using the magnetic compression technique.
METHODS Six male beagles were used as models with two Nd-Fe-B permanent magnets for TEF. The parent magnet and the daughter magnet were placed in the cervical esophagus and trachea, respectively. The anterior wall of the esophagus and the posterior wall of the trachea were compressed when the two magnets coupled. After 4-6 d, the necrotic tissue between the two magnets fell off and the parent and daughter magnets disengaged from the target location, leaving a fistula. Gastroscopy/bronchoscopy, upper gastrointestinal contrast study, and histological analysis were performed.
RESULTS The establishment of the TEF model in all six beagles was successful. The average time of magnet placement was 4.33 ± 1.11 min (range, 3-7 min). Mean time for the magnets to disengage from the target location was 4.67 ± 0.75 d (range, 4-6 d). TEFs were observed by gastroscopy/bronchoscopy and esophageal angiography. The gross anatomical structure of the esophagus and the trachea was in good condition. There was no esophageal mucosa or pseudostratified ciliated columnar epithelium at the site of the fistula according to histological analysis.
CONCLUSION It is simple, feasible, and minimally invasive to use the magnetic compression technique for the establishment of the TEF model in dogs.
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Affiliation(s)
- Yi Gao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Rong-Qian Wu
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Xiao-Peng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
- National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
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16
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Li Y, Sun H, Yan X, Wang S, Dong D, Liu X, Wang B, Su M, Lv Y. Magnetic compression anastomosis for the treatment of benign biliary strictures: a clinical study from China. Surg Endosc 2019; 34:2541-2550. [PMID: 31399950 DOI: 10.1007/s00464-019-07063-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/05/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Magnetic compression anastomosis (MCA) is a revolutionary minimally invasive method to perform choledochocholedochostomy in patients with benign biliary stricture (BBS). We conducted MCA for the treatment of severe BBS that could not be treated by conventional methods. PATIENTS AND METHODS Patients with BBSs that could not be treated using conventional treatments were included. All patients underwent percutaneous transhepatic biliary drainage (PTBD) before MCA, and underwent cholangiography via simultaneous PTBD and endoscopic retrograde cholangiopancreatography (ERCP). The MCA device consisted of a parent and a daughter magnet. The daughter magnet was delivered via the PTBD route to the proximal end of the obstruction, and the parent magnet was delivered via ERCP to the distal end of the obstruction. After recanalization, the MCA device was removed, and biliary stenting (or PTBD) was performed for at least 6 months. RESULTS Of the 9 patients (age 49 ± 12.9 years), 6 had undergone orthotopic liver transplantation. MCA was successful in all 9 patients. The stricture length was 3 ± 1.7 mm, and recanalization occurred after 16.3 ± 13.2 days. Multiple plastic stents (4 patients), fully covered self-expandable metallic stents (4 patients), or PTBD (1 patient) was used after recanalization. Two mild adverse events occurred (cholangitis, 1 patient; biliary bleeding, 1 patient), but were resolved with conservative treatment. Stents were retrieved after > 6 months, and no stenosis occurred during 2-66 months of stent-free follow-up. CONCLUSION The MCA technique is a revolutionary method for choledochocholedochostomy in patients with severe BBS unresponsive to conventional procedures.
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Affiliation(s)
- Yu Li
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Hao Sun
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Xiaopeng Yan
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Shanpei Wang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Dinghui Dong
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Xuemin Liu
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Bo Wang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Maosheng Su
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yi Lv
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
- Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
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Zhao G, Yan X, Ma L, Liu W, Zhang J, Guo H, Liu Y, Lv Y. Biomechanical and Performance Evaluation of Magnetic Elliptical-Ring Compressive Anastomoses. J Surg Res 2019; 239:52-59. [PMID: 30802705 DOI: 10.1016/j.jss.2019.01.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/20/2018] [Accepted: 01/25/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND After magnetic compressive anastomosis, anastomat passage through the narrow channels of the digestive tract is difficult owing to the device's large volume. Such passage can lead to mechanical damage to the digestive tract or anastomat's unstable excretion time. This article presents a new magnetic compressive anastomotic approach. METHODS A magnetic elliptical-ring compressive anastomat was designed and evaluated for placement and passage in vitro. Nine young adult dogs underwent laparotomy with intestinal tissue side-to-side anastomosis. Four different groups of magnetic compressive anastomats of two different magnetic force levels (20 N or 30 N) and shapes (round or elliptical) were implanted into each dog simultaneously. Three dogs were euthanized on each of postoperative day 1, day 4, and day 7. Anastomoses were then compared with respect to histology and tensile fracture force. RESULTS The magnetic elliptical-ring compressive anastomat was functional but produced less obstruction compared to its round counterpart during passage through the esophagus and intestine. Nine dogs underwent successful surgery and harvesting of 30 total anastomoses. Histology of anastomotic tissue showed that, along the newly formed tunnel connecting the two sides of anastomotic tissues, compressed tissues became thinner and fell off, and initial anastomoses formed on the seventh postoperative day. There were large differences in tensile fracture force among the anastomoses formed by magnets with different magnetic forces of the same structure. However, the magnetic compressive anastomat structure did not affect anastomotic repair during magnetic compression anastomosis. CONCLUSIONS The magnetic elliptical-ring compressive anastomat is an efficient anastomotic device that can be used easily and with good passage. The device has good biomechanical properties and can be used with endoscopy to reduce operative time.
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Affiliation(s)
- Guangbin Zhao
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaopeng Yan
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China
| | - Lei Ma
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wenyan Liu
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China
| | - Jing Zhang
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China
| | - Hongchang Guo
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yaxiong Liu
- State Key Laboratory for Mechanical Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Yi Lv
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Xi'an Jiaotong University, Xi'an, China; Shaanxi Province Center for Regenerative Medicine and Surgery Engineering Research, Xi'an Jiaotong University, Xi'an, China.
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18
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Taniguchi D, Matsumoto K, Kondo Y, Tsuchiya T, Yamamoto I, Nagayasu T. New Concept for a Thoracic Drainage System Using Magnetic Actuation. Surg Innov 2019; 26:705-711. [PMID: 31210101 DOI: 10.1177/1553350619851685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives. Thoracic drainage is a common procedure to drain fluid, blood, or air from the pleural cavity. Some attempts to develop approaches to new thoracic drainage systems have been made; however, a simple tube is often currently used. The existing drain presupposes that it is placed correctly and that the tip does not require moving after insertion into the thoracic cavity. However, in some cases, the drain is not correctly placed and reinsertion of an additional drain is required, resulting in significant invasiveness to the patient. Therefore, a more effective drainage system is needed. This study aimed to develop and assess a new thoracic drain via a collaboration between medical and engineering personnel. Methods. We developed the concept of a controllable drain system using magnetic actuation. A dry laboratory trial and accompanying questionnaire assessment were performed by a group of thoracic and general surgeons. Objective mechanical measurements were obtained. Porcine experiments were also carried out. Results. In a dry laboratory trial, use of the controllable drain required significantly less time than that required by replacing the drain. The average satisfaction score of the new drainage system was 4.07 out of 5, indicating that most of the research participants were satisfied with the quality of the drain with a magnetic actuation. During the porcine experiment, the transfer of the tip of the drain was possible inside the thoracic cavity and abdominal cavity. Conclusion. This controllable thoracic drain could reduce the invasiveness for patients requiring thoracic or abdominal cavity drainage.
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Affiliation(s)
- Daisuke Taniguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Program, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Program, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiro Kondo
- Medical-Engineering Hybrid Professional Development Program, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Mechanical Science, Nagasaki University Graduate School, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ikuo Yamamoto
- Medical-Engineering Hybrid Professional Development Program, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Mechanical Science, Nagasaki University Graduate School, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Medical-Engineering Hybrid Professional Development Program, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Akhter A, Pfau P, Benson M, Soni A, Gopal D. Endoscopic management of biliary strictures post-liver transplantation. World J Meta-Anal 2019; 7:120-128. [DOI: 10.13105/wjma.v7.i4.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 02/06/2023] Open
Abstract
Biliary complications play a significant role in morbidity of liver transplant recipients. Biliary strictures occur between 10%-25% of patients with a higher incidence in living donor recipients compared to deceased donors. Strictures can be classified as either anastomotic or non-anastomotic and may be related to ischemic events. Endoscopic management of biliary strictures in the post-transplant setting has become the preferred initial approach due to adequate rates of resolution of anastomotic and non-anastomotic strictures (NAS). However, several factors may increase complexity of the endoscopic approach including surgical anatomy, location, number, and severity of bile duct strictures. Many endoscopic tools are available, however, the approach to management of anastomotic and NAS has not been standardized. Multi-disciplinary techniques may be necessary to achieve optimal outcomes in select patients. We will review the risk factors associated with the development of bile duct strictures in the post-transplant setting along with the efficacy and complications of current endoscopic approaches available for the management of bile duct strictures.
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Affiliation(s)
- Ahmed Akhter
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, United States
| | - Patrick Pfau
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, United States
| | - Mark Benson
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, United States
| | - Anurag Soni
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, United States
| | - Deepak Gopal
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI 53705, United States
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20
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Jang SI, Lee KH, Joo SM, Park H, Choi JH, Lee DK. Maintenance of the fistulous tract after recanalization via magnetic compression anastomosis in completely obstructed benign biliary stricture. Scand J Gastroenterol 2019; 53:1393-1398. [PMID: 30351979 DOI: 10.1080/00365521.2018.1526968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study compared the efficacy of a percutaneous transhepatic cholangioscopy (PTCS) catheter and a fully covered self-expandable metal stent (FCSEMS) for maintaining biliary tract patency after magnetic compression anastomosis (MCA). METHODS This study included patients with completely obstructed benign biliary stricture (BBS), which was resolved by MCA and subsequent insertion of a PTCS catheter or FCSEMS. We compared the restenosis-free time after removal of the PTCS catheter or FCSEMS, and the rate of complications. RESULTS A total of 49 patients were analyzed. The mean ages of the patients in these groups were 50.1 and 49.6 years, respectively. The predisposing conditions causing complete BBS were liver transplantation (n = 38), abdominal surgery (n = 10) and trauma (n = 1). The mean indwelling durations were 176 and 128 days in the PTCS catheter and FCSEMS groups, respectively. The mean follow-up duration after removal of the PTCS catheter and FCSEMS were 2259 and 680.5 days, respectively. Three patients in the PTCS group and three patients in the FCSEMS group experienced stricture relapse. The mean duration between recurrence and stent removal were 924 and 265 days, respectively, and the numbers of stricture-free days did not differ significantly between the two groups. The adverse event rate did not differ significantly between the PTCS and FCSEMS groups (50% vs. 24.2%, respectively). CONCLUSIONS FCSEMSs have an efficacy and safety similar to those of PTCS catheters for maintaining biliary tract patency after MCA, but are more convenient for patients.
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Affiliation(s)
- Sung Ill Jang
- a Department of Internal Medicine , Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Kwang-Hun Lee
- b Department of Radiology , Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Seung-Moon Joo
- b Department of Radiology , Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Hyunsung Park
- a Department of Internal Medicine , Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Jung Hye Choi
- a Department of Internal Medicine , Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Dong Ki Lee
- a Department of Internal Medicine , Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
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21
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Houghton E. Complex percutaneous biliary procedures: Review and contributions of a high volume team. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii180036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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22
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Liu XM, Li Y, Zhang HK, Ma F, Wang B, Wu R, Zhang XF, Lv Y. Laparoscopic Magnetic Compression Biliojejunostomy: A Preliminary Clinical Study. J Surg Res 2018; 236:60-67. [PMID: 30694780 DOI: 10.1016/j.jss.2018.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/06/2018] [Accepted: 11/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Magnetic compression anastomosis is a feasible and effective method for bilioenteric anastomosis (BEA) in animal model. The objective of the present study was to report our initial clinical experience in laparoscopically magnetic compression bilioenteric anastomosis (LMC-BEA). METHODS Patients with obstructive jaundice who were candidates for LMC-BEA were prospectively enrolled from 2013 to 2015. All the procedures were performed laparoscopically. A mother magnet and drainage tube were placed in the proximal bile duct and tightened by a purse suture after dissection of the common bile duct. The drainage tube was introduced into the jejunal lumen at the anastomotic site and guided a daughter magnet to approximate the mother magnet. The two magnets mated at the anastomotic site. All the patients were routinely followed up for magnets discharge till the end of the study. RESULTS In total, four patients with malignant obstructive jaundice and one patient with benign biliary stricture were included. The median age was 70 y (range, 49-74 y). The median time for LMC-BEA was 12 min (range, 8-15 min). A complete anastomosis was confirmed after a median time of 21 d (range, 5-25 d) postoperatively by cholangiography via drainage tube. The magnets were expulsed around 41 d after surgery (range, 12-47 d) postoperatively. With a median follow-up of 313 d (range, 223-1042 d), no complications associated with magnetic anastomosis was documented, such as bile leakage or anastomotic stricture. CONCLUSIONS Magnetic compression is a promising alternate method for laparoscopic BEA. Among the five patients undergoing LMC-BEA, no one developed anastomotic complications.
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Affiliation(s)
- Xue-Min Liu
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Yu Li
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Hong-Ke Zhang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Feng Ma
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Bo Wang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Rongqian Wu
- Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China.
| | - Yi Lv
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi Province, China.
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Ahmad J. Metal, magnet or transplant: options in primary sclerosing cholangitis with stricture. Hepatol Int 2018; 12:510-519. [PMID: 30430358 DOI: 10.1007/s12072-018-9906-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/20/2018] [Indexed: 02/06/2023]
Abstract
Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease of the biliary tree of unknown etiology leading to stricturing and dilation. There is currently no effective medical therapy for PSC and liver transplantation (LT) remains the ultimate treatment for severe disease defined as repeated episodes of cholangitis, decompensated biliary cirrhosis or in exceptional cases, cholangiocarcinoma (CCA). Patients often present with a "dominant" stricture and the therapeutic endoscopist plays an important role in management to improve biliary patency using a variety of techniques that involve sampling, balloon dilation and temporary stenting. Newer modalities such as self-expanding metal stents or magnetic compression anastomosis that have been used in other diseases may have a role to play in PSC but should remain investigational. Liver transplantation for PSC is curative in most cases but the optimal timing remains unclear. The lifetime risk of CCA is 10-15% in PSC patients and LT is often not possible at the time of diagnosis. Multiple studies have tried to identify risk factors and to diagnose CCA at an early stage when surgical resection may be possible or LT can be performed. However, deceased donor organs for LT remain in short supply throughout the world so even identifying PSC patients with CCA at an early stage may not be beneficial unless a live donor organ is available.
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Affiliation(s)
- Jawad Ahmad
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Kubo M, Wada H, Eguchi H, Gotoh K, Iwagami Y, Yamada D, Akita H, Asaoka T, Noda T, Kobayashi S, Nakamura M, Ono Y, Osuga K, Yamanouchi E, Doki Y, Mori M. Magnetic compression anastomosis for the complete dehiscence of hepaticojejunostomy in a patient after living-donor liver transplantation. Surg Case Rep 2018; 4:95. [PMID: 30112678 PMCID: PMC6093822 DOI: 10.1186/s40792-018-0504-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/07/2018] [Indexed: 12/14/2022] Open
Abstract
Background Magnetic compression anastomosis (MCA) is a minimally invasive method of anastomosis that does not involve a surgical procedure in patients with stricture, obstruction, or dehiscence of anastomosis after surgery. We experienced a case of complete dehiscence of bilioenteric anastomosis that was successfully treated by MCA. Case presentation A 55-year-old woman received ABO-incompatible right-lobe living-donor liver transplantation with hepaticojejunostomy for the right anterior duct (RAD) and right posterior duct (RPD). Nineteen days after the operation, bilious and bloody discharge was detected from the abdominal drain. We performed an emergency operation and found that the anastomosis was completely dehiscent. We placed bile drainage catheters into the stumps of the RAD and RPD. She repeatedly experienced cholangitis after the surgery, so we added percutaneous transhepatic cholangial drainage (PTCD) tubes. We decided to treat the complete dehiscence of anastomosis by MCA. One year after the liver transplantation, we performed MCA for the RAD. The bilioenteric fistula was completed 21 days after MCA, and the magnets were retrieved by double-balloon endoscopy. Two months later, MCA for the RPD was also performed by the same procedure. The bilioenteric fistula was not completely established, so we performed double-balloon endoscopy and pulled the magnets down 47 days after MCA for the RAD. The internal/external bile drainage tubes were then left in place to maintain the bilioenteric fistula. Twelve months after MCA for the RAD and 19 months after MCA for the RPD, we removed the tubes without any complications. Conclusion Magnetic compression anastomosis for stricture, obstruction, or dehiscence of the anastomosis after living-donor liver transplantation was an effective and safe procedure.
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Affiliation(s)
- Masahiko Kubo
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan.
| | - Kunihito Gotoh
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Yoshifumi Iwagami
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Tadafumi Asaoka
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Masahisa Nakamura
- Department of Diagnostic and Interventional Radiology, Graduated School of Medicine, Osaka University, Suita city, Osaka prefecture, Japan
| | - Yusuke Ono
- Department of Diagnostic and Interventional Radiology, Graduated School of Medicine, Osaka University, Suita city, Osaka prefecture, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Graduated School of Medicine, Osaka University, Suita city, Osaka prefecture, Japan
| | - Eigoro Yamanouchi
- Department of Radiology, International University of Health and Welfare Hospital, Nasushiobara city, Tochigi prefecture, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Graduated School of Medicine, Osaka University Hospital, 2-2-E2, Yamadaoka, Suita city, Osaka prefecture, 565-0871, Japan
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Jang SI, Lee DK. Anastomotic stricture after liver transplantation: It is not Achilles' heel anymore! INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Woo R, Wong CM, Trimble Z, Puapong D, Koehler S, Miller S, Johnson S. Magnetic Compression Stricturoplasty For Treatment of Refractory Esophageal Strictures in Children: Technique and Lessons Learned. Surg Innov 2017; 24:432-439. [PMID: 28745145 DOI: 10.1177/1553350617720994] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Esophageal stricture is the most common complication following repair of esophageal atresia (EA). In general, these strictures are successfully managed using endoscopic techniques including bougie and balloon dilation, stenting, and chemotherapeutic agent application. If these techniques are unsuccessful, patients require segmental esophageal resection and reanastomosis or esophageal replacement. Magnetic compression anastomosis has been described in children. Herein we report our experience with magnetic compression stricturoplasty to treat refractory strictures after EA repair. METHODS We reviewed our experience using magnets to treat refractory strictures in 2 patients. Both patients failed multiple standard interventions. Because of near complete esophageal obstruction, both patients were candidates for esophageal replacement or segmental resection/anastamosis. In both patients, we applied neodymium-iron-boron magnets using fluoroscopic and endoscopic guidance. RESULTS The magnets were successfully positioned in both cases. Magnets were left in place for 7 and 10 days allowing for gradual compression stricturoplasty/anastamosis. Upon removal of the magnets, recanalization was visualized endoscopically and self-expanding stents were placed. There were no leaks or significant early complications. By 31 months post-magnetic stricturoplasty, both patients achieved durable esophageal patency without dysphagia. CONCLUSION Magnetic stricturoplasty was successful at establishing early patency of the esophagus in 2 patients with recalcitrant EA strictures. Fundamental knowledge of magnetism was critical in configuring magnet arrays for surgery. In both cases, early follow-up is promising. Further follow-up will define the long-term success of this technique.
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Management of biliary anastomotic strictures after liver transplantation. Transplant Rev (Orlando) 2017; 31:207-217. [DOI: 10.1016/j.trre.2017.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 02/06/2017] [Accepted: 03/19/2017] [Indexed: 12/13/2022]
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Saito R, Tahara H, Shimizu S, Ohira M, Ide K, Ishiyama K, Kobayashi T, Ohdan H. Biliary-duodenal anastomosis using magnetic compression following massive resection of small intestine due to strangulated ileus after living donor liver transplantation: a case report. Surg Case Rep 2017; 3:73. [PMID: 28547740 PMCID: PMC5445037 DOI: 10.1186/s40792-017-0349-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/17/2017] [Indexed: 12/28/2022] Open
Abstract
Background Despite the improvements of surgical techniques and postoperative management of patients with liver transplantation, biliary complications are one of the most common and important adverse events. We present a first case of choledochoduodenostomy using magnetic compression following a massive resection of the small intestine due to strangulated ileus after living donor liver transplantation. Case presentation The 54-year-old female patient had end-stage liver disease, secondary to liver cirrhosis, due to primary sclerosing cholangitis with ulcerative colitis. Five years earlier, she had received living donor liver transplantation using a left lobe graft, with resection of the extrahepatic bile duct and Roux-en-Y anastomosis. The patient experienced sudden onset of intense abdominal pain. An emergency surgery was performed, and the diagnosis was confirmed as strangulated ileus due to twisting of the mesentery. Resection of the massive small intestine, including choledochojejunostomy, was performed. Only 70 cm of the small intestine remained. She was transferred to our hospital with an external drainage tube from the biliary cavity and jejunostomy. We initiated total parenteral nutrition, and percutaneous transhepatic biliary drainage was established to treat the cholangitis. Computed tomography revealed that the biliary duct was close to the duodenum; hence, we planned magnetic compression anastomosis of the biliary duct and the duodenum. The daughter magnet was placed in the biliary drainage tube, and the parent magnet was positioned in the bulbus duodeni using a fiberscope. Anastomosis between the left hepatic duct and the duodenum was accomplished after 25 days, and the biliary drainage stent was placed over the anastomosis to prevent re-stenosis. Contributions to the successful withdrawal of parenteral nutrition were closure of the ileostomy in the adaptive period, preservation of the ileocecal valve, internal drainage of bile, and side-to-side anastomosis. Conclusions Choledochoduodenostomy with magnet compression could be a less invasive and safer method for treatment of biliary stricture that cannot be accessed by conventional surgery.
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Affiliation(s)
- Ryusuke Saito
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, 734-8551, Japan.
| | - Seiichi Shimizu
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Kohei Ishiyama
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, Hiroshima, 734-8551, Japan
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Jang SI, Lee KH, Yoon HJ, Lee DK. Treatment of completely obstructed benign biliary strictures with magnetic compression anastomosis: follow-up results after recanalization. Gastrointest Endosc 2017; 85:1057-1066. [PMID: 27619787 DOI: 10.1016/j.gie.2016.08.047] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 08/27/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Although nonsurgical methods produce high clinical success rates in the treatment of benign biliary stricture (BBS), conventional methods are not always successful in cases of severe biliary stricture or complete obstruction. Therefore, the efficacy of magnetic compression anastomosis (MCA) for treatment of refractory BBS was evaluated in a single-center, nonrandomized study. METHODS MCA was performed in patients with BBS that was not resolved by conventional endoscopic or percutaneous treatments. One magnet was delivered through the percutaneous transhepatic biliary drainage tract, and the other advanced through 1 of 3 different routes. After magnet approximation and recanalization, an internal drainage catheter was placed for 6 months. RESULTS This study followed 39 patients who underwent MCA after the development of postoperative or traumatic strictures. Recanalization was achieved successfully in 35 patients. There was an acceptable procedure-related adverse event of mild cholangitis in 1 patient and no procedure-related mortalities. The average elapsed time from magnet approximation to removal was 57.4 days (range, 13-182 days), and the mean follow-up period after recanalization was 41.9 months (range, 7.1-73.4 months). Restenosis after MCA recurred in 1 patient, and partial restenosis occurred in another patient, but recanalization in these patients was successful using a guidewire via the percutaneous and endoscopic tracts. CONCLUSIONS MCA represents an alternative nonsurgical recanalization method for BBSs that cannot be treated by conventional methods. The rate of stricture recurrence after MCA was lower than that after conventional methods, likely because of the creation of a new fistula tract instead of dilation of a previous stricture.
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Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea; Department of Medicine, The Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Kwang-Hun Lee
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hong Jin Yoon
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Lee HW, Shah NH, Lee SK. An Update on Endoscopic Management of Post-Liver Transplant Biliary Complications. Clin Endosc 2017; 50:451-463. [PMID: 28415168 PMCID: PMC5642064 DOI: 10.5946/ce.2016.139] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/16/2017] [Accepted: 02/22/2017] [Indexed: 02/07/2023] Open
Abstract
Biliary complications are the most common post-liver transplant (LT) complications with an incidence of 15%-45%. Furthermore, such complications are reported more frequently in patients who undergo a living-donor LT compared to a deceased-donor LT. Most post-LT biliary complications involve biliary strictures, bile leakage, and biliary stones, although many rarer events, such as hemobilia and foreign bodies, contribute to a long list of related conditions. Endoscopic treatment of post-LT biliary complications has evolved rapidly, with new and effective tools improving both outcomes and success rates; in fact, the latter now consistently reach up to 80%. In this regard, conventional endoscopic retrograde cholangiopancreatography remains the preferred initial treatment. However, percutaneous transhepatic cholangioscopy is now central to the management of endoscopy-resistant cases involving complex hilar or multiple strictures with associated stones. Many additional endoscopic tools and techniques-such as the rendezvous method, magnetic compression anastomosis , and peroral cholangioscopy-combined with modified biliary stents have significantly improved the success rate of endoscopic management. Here, we review the current status of endoscopic treatment of post-LT biliary complications and discuss conventional as well as the aforementioned new tools and techniques.
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Affiliation(s)
- Hyun Woo Lee
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Najmul Hassan Shah
- Division of Gastroenterology and Hepatology, Liver Transplant Program, Shifa International Hospital Ltd., Shifa College of Medicine, Islamabad, Pakistan
| | - Sung Koo Lee
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Parlak E, Koksal AS, Kucukay F, Eminler AT, Toka B, Uslan MI. A novel technique for the endoscopic treatment of complete biliary anastomosis obstructions after liver transplantation: through-the-scope magnetic compression anastomosis. Gastrointest Endosc 2017; 85:841-847. [PMID: 27566054 DOI: 10.1016/j.gie.2016.07.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Magnetic compression anastomosis is a rescue technique for recanalization of complete biliary strictures. Here, we present magnetic compression anastomosis with novel through-the-scope magnets in patients with complete duct-to-duct anastomosis obstruction after liver transplantation. METHODS The magnets were 2 and 2.4 mm in diameter, with a hole at the center for inserting a guidewire. One of the magnets was advanced through the scope up to the distal site of the stricture by using a 7F pusher. The other magnet was pushed percutaneously through the 10F sheath. The procedure was terminated when the magnets were approximated or properly aligned. Recanalization was followed by percutaneous cholangiography. Patients underwent multiple plastic stenting after recanalization was achieved. RESULTS Nine patients with a stricture length of less than 1 cm, a stump in the donor bile ducts close to the stricture, and proper positioning of the bile duct stumps, underwent magnetic compression anastomosis. Seven patients had a live donor-related liver transplantation. The mean stricture time was 24.1 ± 17.1 months. The mean stricture length was 4.0 ± 1.2 mm. Recanalization was achieved in 7 patients (77%) after a mean recanalization time of 8.1 ± 4.7 days. There was no recurrence after 4.8 ± 3.8 months of stent-free follow-up. No adverse events were observed. CONCLUSIONS The through-the-scope magnet procedure was effective in the recanalization of complete anastomotic biliary obstructions after liver transplantation in a selected group of patients with a short stricture length and an appropriate anatomy.
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Affiliation(s)
- Erkan Parlak
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Aydın Seref Koksal
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Fahrettin Kucukay
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey
| | - Ahmet Tarık Eminler
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Bilal Toka
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mustafa Ihsan Uslan
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Abstract
BACKGROUND Obesity treatment options are of great interest worldwide with major developments in the past 20 years. From general surgery to natural orifice transluminal endoscopic surgery intervention nowadays, obesity surgical therapies have surely developed and are now offering a variety of possibilities. AREAS OF UNCERTAINTY Although surgery is the only proven approach for weight loss, a joint decision between the physician and patient is required before proceeding to such a procedure. With a lot of options available, the treatment should be individualized because the benefits of surgical intervention must be weighed against the surgical risks. DATA SOURCES Medline search to locate full-text articles and abstracts with obvious conclusions by using the keywords: obesity, surgical endoscopy, gastric bypass, bariatric surgery, and endoscopic surgery, alone and in various combinations. Additional relevant publications were also searched using the reference lists of the identified articles as a starting point. RESULTS Laparoscopic Roux-en-Y gastric bypass still is the most effective, less invasive, bariatric surgical intervention, although there are various complications encountered, such as postoperative hemorrhage (1.9%-4.4%), internal hernias, anastomotic strictures (2.9%-23%), marginal ulcerations (1%-16%), fistulas (1.5%-6%), weight gain, and nutritional deficiencies. However, the absence of parietal incisions, less pain, decreased risk of infection, and short hospital stay make room for endoscopic surgery as a possible valid option for obesity for both the doctors' and the patients' perspective. CONCLUSIONS The current tendency is to promote surgical treatment of obesity to a status of less invasive scars therefore promoting minimally invasive surgical techniques.
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Zhang H, Tan K, Fan C, Du J, Li J, Yang T, Lv Y, Du X. Magnetic compression anastomosis for enteroenterostomy under peritonitis conditions in dogs. J Surg Res 2017; 208:60-67. [DOI: 10.1016/j.jss.2016.08.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/23/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022]
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Oh HC. Percutaneous Transhepatic Cholangioscopy in Bilioenteric Anastomosis Stricture. Clin Endosc 2016; 49:530-532. [PMID: 27642850 PMCID: PMC5152783 DOI: 10.5946/ce.2016.125] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 12/12/2022] Open
Abstract
Bilioenteric anastomosis strictures are a serious complication of biliary surgery, and often result in recurrent cholangitis, choledocholithiasis, biliary cirrhosis, and hepatic failure. Bilioenteric reconstructive surgery is the standard treatment of choice for such complications. However, percutaneous transhepatic cholangioscopy (PTCS), also known as per-oral endoscopic-guided intervention, is a less invasive procedure that is becoming an increasingly popular alternative. This review describes the PTCS procedure (including the preparation process), as well as the diagnostic and therapeutic role of PTCS in bilioenteric anastomosis strictures.
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Affiliation(s)
- Hyoung-Chul Oh
- Division of Gastroenterology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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35
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Nam K, Lee SK, Song TJ, Park DH, Lee SS, Seo DW, Kim MH. Percutaneous transhepatic cholangioscopy for biliary complications after liver transplantation: a single center experience. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:650-657. [PMID: 27474863 DOI: 10.1002/jhbp.388] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Some biliary complications after liver transplantation (LT) are difficult to manage by endoscopic or radiologic intervention alone. In these cases, percutaneous transhepatic cholangioscopy (PTCS) can be used as an adjuvant option. METHODS Patients who underwent PTCS for post-LT biliary complications between August 1992 and January 2016 were retrospectively reviewed. RESULTS Fifteen patients underwent PTCS for post-LT biliary complications. The median age at LT was 47 years and 11 patients were male. Indications for LT were as follows: decompensated liver cirrhosis (n = 9), hepatocellular carcinoma (n = 5), and acute fulminant liver failure (n = 1). Single living donor was common (n = 11) and duct-to-duct anastomosis was performed in 11 patients. The median age at PTCS was 52 years and indications for PTCS were as follows: intrahepatic duct stone (n = 10), common bile duct stone (n = 1), biliary cast (n = 1), and biliary stricture (n = 3). There were no significant PTCS-related morbidity and mortality. However, four patients (26.7%) needed additional radiologic intervention (n = 2) or surgery (n = 2) after PTCS. CONCLUSIONS Percutaneous transhepatic cholangioscopy in conjunction with endoscopic and radiologic interventions can aid in managing post-LT biliary complications and avoiding reoperation.
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Affiliation(s)
- Kwangwoo Nam
- Division of Gastroenterology, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea
| | - Sung Koo Lee
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Do Hyun Park
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sang Soo Lee
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Dong-Wan Seo
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Myung-Hwan Kim
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Shin M, Joh JW. Advances in endoscopic management of biliary complications after living donor liver transplantation: Comprehensive review of the literature. World J Gastroenterol 2016; 22:6173-6191. [PMID: 27468208 PMCID: PMC4945977 DOI: 10.3748/wjg.v22.i27.6173] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/25/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
Apart from noticeable improvements in surgical techniques and immunosuppressive agents, biliary complications remain the major causes of morbidity and mortality after living donor liver transplantation (LDLT). Bile leakage and stricture are the predominant complications. The reported incidence of biliary complications is 15%-40%, and these are known to occur more frequently in living donors than in deceased donors. Despite the absence of a confirmed therapeutic algorithm, many approaches have been used for treatment, including surgical, endoscopic, and percutaneous transhepatic techniques. In recent years, nonsurgical approaches have largely replaced reoperation. Among these, the endoscopic approach is currently the preferred initial treatment for patients who undergo duct-to-duct biliary reconstruction. Previously, endoscopic management was achieved most optimally through balloon dilatation and single or multiple stents placement. Recently, there have been significant developments in endoscopic devices, such as novel biliary stents, as well as advances in endoscopic technologies, including deep enteroscopy, the rendezvous technique, magnetic compression anastomosis, and direct cholangioscopy. These developments have resulted in almost all patients being managed by the endoscopic approach. Multiple recent publications suggest superior long-term results, with overall success rates ranging from 58% to 75%. This article summarizes the advances in endoscopic management of patients with biliary complications after LDLT.
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Wadhawan M, Kumar A. Management issues in post living donor liver transplant biliary strictures. World J Hepatol 2016; 8:461-470. [PMID: 27057304 PMCID: PMC4820638 DOI: 10.4254/wjh.v8.i10.461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
Biliary complications are common after living donor liver transplant (LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography (ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage (PTBD) and rendezvous technique. A minority of patients may require surgical correction. ERCP for these strictures is technically more challenging than routine as well post deceased donor strictures. Biliary strictures may increase the morbidity of a liver transplant recipient, but the mortality is similar to those with or without strictures. Post transplant strictures are short segment and soft, requiring only a few session of ERCP before complete dilatation. Long-term outcome of patients with biliary stricture is similar to those without stricture. With the introduction of new generation cholangioscopes, ERCP success rate may increase, obviating the need for PTBD and surgery in these patients.
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Magnets for therapy in the GI tract: a systematic review. Gastrointest Endosc 2015; 82:237-45. [PMID: 25936447 DOI: 10.1016/j.gie.2014.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 11/04/2014] [Indexed: 12/13/2022]
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Abstract
UNLABELLED Biliary complications (BCs) remain one of the most outstanding factors influencing long-term results after orthotopic liver transplantation. The authors carried out a systematic overview of 1720 papers since 2008, and focused on 45 relevant ones. Among 14,411 transplanted patients the incidence of BCs was 23%. Biliary leakage occurred in 8.5%, biliary stricture in 14.7%, mortality rate was 1-3%. RISK FACTORS preoperative sodium level; p = 0.037, model of end-stage liver disease score >25; p = 0.048, primary sclerosing cholangitis; p = 0.001, malignancy; p = 0.026, donor age >60, macrovesicular graft steatosis; p = 0.001, duct-to-duct anastomosis; p = 0.004, long anhepatic phase; p = 0.04, cold ischemic time >12 h; p = 0.043, use of T-tube; p = 0.032, insufficient flush of bile ducts; p = 0.001, acute rejection; p = 0.003, cytomegalovirus infection; p = 0.004 and hepatic artery thrombosis; p = 0.001. The management was surgical in case of biliary leakage, and interventional radiology or endoscopic retrograde cholangiopancreatography in case of biliary stricture. Mapping of miRNA profile is a new field of research. Nemes-Doros score is a useful tool in the estimation of hepatic artery thrombosis. Management of BCs requires a multidisciplinary expert team.
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Affiliation(s)
- Balázs Nemes
- Division of Transplantation, Institute of Surgery, Clinical Centre, University of Debrecen, Moricz Zs. krt. 22, Debrecen, H-4032, Hungary
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Jang SI, Choi J, Lee DK. Magnetic compression anastomosis for treatment of benign biliary stricture. Dig Endosc 2015; 27:239-49. [PMID: 24905938 DOI: 10.1111/den.12319] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/30/2014] [Indexed: 12/13/2022]
Abstract
Endoscopic and percutaneous procedures have shown high success rates when used to treat benign biliary stricture. However, cases in which a guidewire cannot be passed through a refractory stricture or a complete obstruction are difficult to treat using conventional methods. Magnetic compression anastomosis (MCA) has emerged as a non-surgical alternative avoiding operational mortality and morbidity. The feasibility and safety of MCA have been experimentally and clinically verified in cases of biliobiliary and bilioenteric anastomosis. However, no pre-MCA assessment modality capable of predicting outcomes is as yet available, and no universally effective magnet delivery method has as yet been established, rendering it difficult to identify patients for whom MCA is appropriate. Various experimental studies seeking to overcome these limitations are underway. Such work will improve our in-depth understanding of MCA, which has been trialed in various fields. Upon further development, MCA may become a ground-breaking option for treatment of benign strictures that are difficult to resolve using conventional methods, and MCA may be expected to be minimally traumatic and highly effective. The aim of the present study was to discuss the current status of MCA and the direction of MCA development by reviewing clinical and experimental MCA data.
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Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Russell KW, Rollins MD, Feola GP, Scaife ER. Magnamosis: a novel technique for the management of rectal atresia. BMJ Case Rep 2014; 2014:bcr-2013-201330. [PMID: 25096648 DOI: 10.1136/bcr-2013-201330] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We report a case of rectal atresia treated using magnets to create a rectal anastomosis. This minimally invasive technique is straightforward and effective for the treatment of rectal atresia in children.
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Affiliation(s)
- Katie W Russell
- Division of Pediatric Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Michael D Rollins
- Division of Pediatric Surgery, University of Utah, Salt Lake City, Utah, USA
| | - G Peter Feola
- Division of Pediatric Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Eric R Scaife
- Division of Pediatric Surgery, University of Utah, Salt Lake City, Utah, USA
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Yan XP, Liu WY, Li DC, Lv Y. Magnamosis combined with endoscopy: A new endoscopic technique in digestive surgery. Shijie Huaren Xiaohua Zazhi 2014; 22:2716-2721. [DOI: 10.11569/wcjd.v22.i19.2716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Conventional hand-sewn technique is the basic method for anastomosis in the gastrointestinal tract. However, with the rapid development of minimally invasive surgery and the spread of fast track surgery, hand-sewn technique cannot satisfy the requirements of modern surgery. The common goal that the majority of surgeons seek to achieve has changed: to reduce surgical invasion and operative time as minimally as possible, on the premise that therapeutic and anastomotic effects can be guaranteed. Therefore, after more than 30 years of exploration and development, magnamosis as a novel anastomosis technique shows its significant superiority in anastomosis or recanalization in the gastrointestinal tract. Furthermore, the combination of magnamosis and endoscopy may transform part of the surgical procedures into endoscopic procedures. This review aims to elucidate the application and future development of magnamosis combined with endoscopy in anastomosis or recanalization in the gastrointestinal tract.
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Zaritzky M, Ben R, Johnston K. Magnetic gastrointestinal anastomosis in pediatric patients. J Pediatr Surg 2014; 49:1131-7. [PMID: 24952802 DOI: 10.1016/j.jpedsurg.2013.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/29/2013] [Accepted: 11/02/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE To describe 17 patients who underwent magnetic, non-surgical gastrointestinal (GI) anastomoses. METHODS Patients with GI obstruction, stenosis, or atresia were treated with image-guided and/or endoscopically placed discoid magnet pairs or catheter-based bullet-shaped magnet pairs. RESULTS Anastomosis was achieved in 7 days in an 11-year-old with gastric outlet obstruction due to metastatic colon cancer. Anastomosis was achieved in 8 and 10 days in 2 patients (age 2.0 years and 3.4 years) who had rectocolonic stenosis. Re-anastomosis was achieved in an average of 6 days (range 3 to 7 days) in 5 patients (age 6 months to 5.9 years) with severe recurrent postsurgical esophageal stenosis refractory to dilatation. Primary esophageal anastomosis was achieved in an average of 4.2 days (range 3 to 6 days) in 9 patients with esophageal atresia (Type A or Type C surgically converted to Type A) with a gap length of 4 cm or less. The average age of these esophageal atresia patients was 3 months (range 23 days to 5 months). CONCLUSION Minimally invasive magnet placement was feasible and achieved anastomosis in all patients.
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Affiliation(s)
- Mario Zaritzky
- Department of Radiology, The University of Chicago Medicine, Comer Children's Hospital, 5721S. Maryland Avenue, Chicago, IL 60637, USA.
| | - Ricardo Ben
- Department of Gastroenterology, Hospital de Niños de La Plata, Calle 14 Nro 1631, La Plata, Buenos Aires, Argentina
| | - Krystal Johnston
- MED Institute, Inc., 1 Geddes Way, West Lafayette, IN 47906, USA
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Section 11. Radiological intervention approaches to biliary complications after living donor liver transplantation. Transplantation 2014; 97 Suppl 8:S43-6. [PMID: 24849833 DOI: 10.1097/01.tp.0000446275.51428.65] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although endoscopic treatment has become the first choice to treat biliary complications, percutaneous transhepatic treatment still has important roles to treat biliary stricture or leak after living donor liver transplantation. This study reviewed a total of 527 recipients who had undergone percutaneous transhepatic treatment to treat biliary stricture (n=498) and leaks (n=29). Percutaneous transhepatic treatment included percutaneous transhepatic biliary drainage, perihepatic biloma drainage, balloon dilation of biliary stricture, and drainage catheter interposition or retrievable covered stent placement across a stricture or leak segment. Clinical success was achieved in 440 (88.4%) recipients with biliary stricture and 19 (65.5%) recipients with bile leaks. Percutaneous transhepatic treatment seems to be an effective alternative for treating biliary complications resistant to or inaccessible by endoscopic treatment.
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Shin M, Joh JW. Section 10. Endoscopic management of biliary complications in adult living donor liver transplantation. Transplantation 2014; 97 Suppl 8:S36-43. [PMID: 24849832 DOI: 10.1097/01.tp.0000446274.13310.b9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Living donor liver transplantation (LDLT) has become an accepted therapeutic option for patients with end-stage liver disease. However, biliary complications remain the major causes of morbidity and mortality for LDLT recipients. Although there are currently no reports of a clear therapeutic algorithm, many approaches have been developed to treat biliary complications, including surgical, endoscopic, and percutaneous transhepatic techniques. Endoscopic treatment is currently the preferred initial treatment for patients that have previously undergone duct-to-duct biliary reconstruction. This article discusses aspects of endoscopic management of biliary complications that occur in adult LDLT.
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Affiliation(s)
- Milljae Shin
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2 Address correspondence to: Jae-Won Joh, M.D., Ph.D., Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea
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Liu SQ, Lei P, Cui XH, Lv Y, Li JH, Song YL, Zhao G. Sutureless anastomoses using magnetic rings in canine liver transplantation model. J Surg Res 2013; 185:923-33. [DOI: 10.1016/j.jss.2013.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/04/2013] [Accepted: 07/11/2013] [Indexed: 01/16/2023]
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Recanalization of completely obstructed bilioenteric anastomoses using a needle knife puncture. GASTROINTESTINAL INTERVENTION 2013. [DOI: 10.1016/j.gii.2013.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lambe T, Ríordáin MGÓ, Cahill RA, Cantillon-Murphy P. Magnetic compression in gastrointestinal and bilioenteric anastomosis: how much force? Surg Innov 2013; 21:65-73. [PMID: 23592733 DOI: 10.1177/1553350613484824] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM The concept of compression alimentary anastomosis is well established. Recently, magnetic axial alignment pressures have been encompassed within such device constructs. We quantify the magnetic compression force and pressure required to successfully achieve gastrointestinal and bilioenteric anastomosis by in-depth interrogation of the reported literature. METHODS Reports of successful deployment and proof of anastomotic patency on survival were scrutinized to quantify the necessary dimensions and strengths of magnetic devices in (a) gastroenteral anastomosis in live porcine models and (b) bilioenteric anastomosis in the clinical setting. Using a calculatory tool developed for this work (magnetic force determination algorithm, MAGDA), ideal magnetic force and compression pressure were quantified from successful reports with regard to their variance by intermagnet separation. RESULTS Optimized ranges for both compression force and pressure were determined for successful porcine gastroenteral and clinical bilioenteric anastomoses. For gastroenteral anastomoses (porcine investigations), an optimized compression force between 2.55 and 3.57 kg at 2-mm intermagnet separation is recommended. The associated compression pressure should not exceed 60 N/cm(2). Successful bilioenteric anastomoses is best clinically achieved with intermagnet compression of 18 to 31 g and associated pressures between 1 and 3.5 N/mm(2) (at 2-mm intermagnet separation). CONCLUSION The creation of magnetic compression anastomoses using permanent magnets demonstrates a remarkable resilience to variations in magnetic force and pressure exertion. However, inappropriate selection of compression characteristics and magnet dimensions may incur difficulties. Recommendations of this work and the availability of the free online tool (http://magda.ucc.ie/) may facilitate a factor of robustness in the design and refinement of future devices.
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Abstract
Although some technical challenges in the development of dedicated devices need to be overcome, endoscopic ultrasonography (EUS)-guided anastomosis is promising as a minimally invasive technique for pancreatobiliary diseases.
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Affiliation(s)
- Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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