1
|
Zhang G, Liang Z, Zhao G, Zhang S. Endoscopic application of magnetic compression anastomosis: a review. J Gastroenterol Hepatol 2024. [PMID: 38638082 DOI: 10.1111/jgh.16574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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.
Collapse
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
| |
Collapse
|
2
|
Krishnan N, Pakkasjärvi N, Kainth D, Danielson J, Verma A, Yadav DK, Goel P, Anand S. Role of Magnetic Compression Anastomosis in Long-Gap Esophageal Atresia: A Systematic Review. J Laparoendosc Adv Surg Tech A 2023; 33:1223-1230. [PMID: 37603306 DOI: 10.1089/lap.2023.0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
Background: Magnetic compression anastomosis (MCA) is an alternative technique for patients with long-gap esophageal atresia (EA). It allows for preservation of the native esophagus. We aimed to systematically summarize the current literature on MCA in EA. Methods: Studies where neonates with EA were treated with MCA devices were included, while studies on esophageal stenosis were excluded. All clinical studies, including comparative studies, case series, and case reports, were eligible for inclusion. Methodological quality assessment was performed using a validated tool. Results: Twelve studies with a total of 42 patients were included in this review. There was a wide variation among these studies with regard to the time of initiation of MCA (1 day to 7 months), procedure time (13-320 minutes), and magnet characteristics (strength, size, and shape of the magnets used). The time to achieve anastomosis ranged from 1 to 12 days. Stricture at the anastomotic site was reported in almost all the patients, which required multiple endoscopic dilatations (median no. of dilatations/patient = 9.8). Stent placement for refractory stricture was required in 9 (21%) patients, and surgery for stricture was required in 6 (14%) patients. Long-term outcomes included esophageal dysmotility (n = 3) and recurrent pulmonary infections (n = 3) were reported in only four studies. Conclusion: As per the findings of this review, neonates with long-gap EA undergoing MCA would invariably require multiple sittings of endoscopic dilatations (median no. of dilatations/patient = 9.8). Also, there is a wide variation among the included studies in terms of the procedure of MCA. Future studies with a standardized procedure for achieving MCA are needed to determine additional outcomes in this fragile patient population.
Collapse
Affiliation(s)
- Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Niklas Pakkasjärvi
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
| | - Deepika Kainth
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Johan Danielson
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
| | - Ajay Verma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prabudh Goel
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
3
|
Kotlovsky AM, Muensterer OJ, Nikolaev VV, Razumovskiy AY. Magnetic Compression Anastomosis-Past Experience and Current Proposals for Further Development in Pediatric Minimally Invasive Surgery. Children (Basel) 2023; 10:1328. [PMID: 37628327 PMCID: PMC10453638 DOI: 10.3390/children10081328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/16/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
Originating in the 1970s, magnetic compression anastomosis (MCA) has lately been revisited with a focus on minimal invasive surgery (MIS). The aim of this report is to reappraise our earlier experience with MCA with the intention of facilitating future MCA advancement. A retrospective review was conducted regarding preclinical experiments and clinical trials at a single institution from 1980 to 1995. The reviewed information was compiled and appraised to generate proposals for future MCA use. The experimental studies, including 250 MCA cases in gastrointestinal and urinary tract animal models, demonstrated the technical versatility of MCA as well as the superior biomechanical characteristics in comparison to hand-sewn anastomoses. Clinical trials encompassed 87 MCA procedures in 86 children, 2 to 10 years of age, involving the following techniques: non-operative esophageal recanalization (n = 15), non-operative ileostomy undiversion (n = 46), Swenson pull-through (n = 10), non-operative urethral recanalization (n = 5), and extravesical ureterocystoneostomy (n = 11). Clinical MCA was found to be successful in over 87% of cases. MCA limitations concerning anastomotic failure and scarring were thought to be mostly due to inadequate magnetic compression. Based on our historic experience, we propose further research on the technical aspects of MCA, along with the biological aspects of anastomotic tissue remodeling. Magnets should be designed and manufactured for a wide spectrum of pediatric surgical indications, particularly in combination with novel MIS techniques.
Collapse
Affiliation(s)
- Anatole M. Kotlovsky
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Medical Center, Lindwurmstrasse, 480337 Munich, Germany;
| | - Oliver J. Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Medical Center, Lindwurmstrasse, 480337 Munich, Germany;
| | - Vasily V. Nikolaev
- Department of Pediatric Surgery, N.I. Pirogov Russian National Research Medical University, Russian Children’s Hospital, Leninsky Prosp 117, 119571 Moscow, Russia; (V.V.N.); (A.Y.R.)
| | - Alexander Y. Razumovskiy
- Department of Pediatric Surgery, N.I. Pirogov Russian National Research Medical University, Russian Children’s Hospital, Leninsky Prosp 117, 119571 Moscow, Russia; (V.V.N.); (A.Y.R.)
- Department of Pediatric Surgery, Pirogov Russian National Research Medical University, Filatov Children’s Clinical Hospital, Ulitsa Sadovo-Kudrinskay 13, 123001 Moscow, Russia
| |
Collapse
|
4
|
Liu S, Fang Y, Lv Y, Zhao J, Luo R, Luo R, Cheng J, Yang H, Zhang A, Shen Y, Jiang N. Magnetic compression stricturoplasty in patients with severe stricture after simultaneous esophageal atresia and duodenal obstruction repair: A case report. Exp Ther Med 2022; 23:93. [PMID: 34976135 PMCID: PMC8674971 DOI: 10.3892/etm.2021.11016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/07/2021] [Indexed: 01/27/2023] Open
Abstract
Combined esophageal atresia (EA), tracheoesophageal fistula (TEF) and duodenal obstruction result in various challenges in management, and a well-defined management protocol is still lacking. Esophageal stricture is the most common complication after EA repair. The use of magnetic compression alimentary tract anastomosis has been reported in children. By searching the literature, the present study reports the first case of simultaneous repair (EA repair followed by duodenal obstruction repair) and magnetic compression stricturoplasty for refractory esophageal stricture after EA repair in two male neonates. One of the neonates received delayed treatment of duodenal obstruction, and the other successfully underwent a simultaneous emergency operation of these combined anomalies. These two infants developed refractory strictures despite multiple endoscopic dilatation procedures during the postoperative follow-up period. Magnetic compression stricturoplasty procedures were successfully performed under fluoroscopic and endoscopic guidance without any leakage or complication. At the follow-up 10-months after stricturoplasty, the two patients achieved durable esophageal patency in the absence of dysphagia. Combination of early chest and abdominal X-ray detection is recommended to avoid a delayed diagnosis and treatment, as well as the synchronous operation for EA/TEF repair and duodenoduodenostomy in a single surgery for combined EA/TEF and duodenal obstructions. Therefore, magnetic compression stricturoplasty is a feasible and efficient method for establishing early patency of the esophagus in patients with refractory EA stricture.
Collapse
Affiliation(s)
- Shiqi Liu
- Department of Nursing, Medical College, Xijing University, Xi'an, Shaanxi 710123, P.R. China
| | - Ying Fang
- Department of Digestive Diseases, Xi'an Children's Hospital, Xi'an, Shaanxi 710003, P.R. China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jingru Zhao
- Department of Pediatrics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Ruixue Luo
- Corrosion and Protection Research Lab (CPRL), Northwest Institute for Nonferrous Metal Research, Xi'an, Shaanxi 710016, P.R. China
| | - Ruogu Luo
- Department of Pediatrics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Jun Cheng
- Pediatric Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Hongbin Yang
- Department of Digestive Diseases, Xi'an Children's Hospital, Xi'an, Shaanxi 710003, P.R. China
| | - Anpeng Zhang
- Department of Pediatrics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Yingchun Shen
- Pediatric Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Na Jiang
- Department of Anesthesia, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| |
Collapse
|
5
|
Kawabata H, Nakase K, Okazaki Y, Yamamoto T, Yamaguchi K, Ueda Y, Miyata M, Motoi S. Endoscopic ultrasonography for pre-operative local assessment and endoscopic ultrasonography-guided marking before gastrojejunostomy for duodenal obstruction using magnetic compression anastomosis. J Clin Transl Res 2021; 7:621-624. [PMID: 34778591 PMCID: PMC8580526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIM A 93-year-old woman who was bedridden with severe dementia was referred to our department with a 3-day history of repeated vomiting after meals. Computed tomography revealed significant dilatation of the duodenum up to the level of the third portion, which was compressed by a large, low-density mass. Upper gastrointestinal endoscopy showed narrowing of the third portion of the duodenum with edematous mucosa covered with multiple white spots, where the endoscope was able to pass through with mild resistance. B-cell lymphoma was histopathologically suspected from biopsy specimens of the mucosa. We performed gastrojejunostomy through the magnetic compression anastomosis (MCA) technique. We prepared two neodymium magnets: Flat plate shaped (15 × 3 mm) with a small hole 3 mm in diameter; a nylon thread was passed through each hole. We then confirmed the absence of no non-target tissue, including large vessels and intestine adjacent to the anastomosis where the magnets were to be placed using endoscopic ultrasonography (EUS) from the stomach. EUS-guided marking using biopsy forceps by biting the mucosa and placing a hemoclip was performed at the anastomosis site in the stomach. The magnet was pushed and delivered to the duodeno-jejuno junction, and another magnet was delivered to the marking point in the stomach. The magnets were attracted toward each other transmurally. The magnets fell into the colon by 11 days after starting the compression, and the completion of gastrojejunostomy was confirmed. RELEVANCE FOR PATIENTS Endoscopic gastrojejunostomy using MCA is useful as a minimally invasive alternative treatment for duodenal obstruction. EUS for the pre-operative local assessment and EUS-guided marking can ensure the safety of the MCA procedure.
Collapse
Affiliation(s)
- Hideaki Kawabata
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Japan,Corresponding author: Hideaki Kawabata Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, 100 Nishinokuchi, Sayama, Kumiyama-cho, Kuze-gun, Kyoto 613-0034, Japan. E-mail:
| | - Kojiro Nakase
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Japan
| | - Yuji Okazaki
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Japan
| | - Tetsuya Yamamoto
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Japan
| | | | - Yuki Ueda
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Japan
| | - Masatoshi Miyata
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Japan
| | - Shigehiro Motoi
- Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, Japan
| |
Collapse
|
6
|
Liu SQ, Li QF, Lv Y, Zhao JR, Luo RX, Zhang PF, Guo JZ, Zhang AP, Li QH. Magnetic compression anastomosis for rectal atresia following necrotizing enterocolitis: A case report. Medicine (Baltimore) 2020; 99:e23613. [PMID: 33327332 PMCID: PMC7738055 DOI: 10.1097/md.0000000000023613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Rectal atresia caused by necrotizing enterocolitis (NEC) is a serious and rare complication in children. Magnetic compression anastomosis (MCA) has been effectively applied in children with congenital oesophageal atresia and biliary atresia. Herein, we reported a case of successfully application of MCA in an infant with rectal atresia following NEC. PATIENT CONCERNS A 30 weeks premature birth female fetal infant was transferred to our neonatal intensive care unit due to premature delivery, low birth weight, and neonatal respiratory distress. On postpartum day 11, the infant developed abdominal distension and mucosanguineous feces. This infant was then clinically diagnosed as NEC. She underwent anesthesia and intestinal fistula operation on postpartum day 11 because of NEC. DIAGNOSIS After 3 months, radiographic examination revealed rectal atresia and stricture. INTERVENTIONS This infant was successfully treated with MCA following a cecum-rectal anastomosis and ileocecal valve was reserved. OUTCOMES On postoperative day 9, she passed the 2 magnets per rectum. In addition, there were no difficult defecation or fecal incontinence or other short-term complications. After the 7-month follow-up, the patient had an excellent clinical outcome. LESSONS MCA is a feasible and effective method for treating rectal atresia in infants.
Collapse
Affiliation(s)
- Shi-Qi Liu
- Department of Neonatal Surgery, the Children Hospital of Xi’an City, Xi’an
| | - Qi-Feng Li
- Xinjiang Institute of Pediatrics, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Jing-Ru Zhao
- Department of Pediatrics, The Northwest Women's and Children's Hospital
| | - Rui-Xue Luo
- Corrosion & Protection Research Lab, The Northwest Institute for Nonferrous Metal Research (NIN)
| | - Peng-Fei Zhang
- Department of Pediatrics, The Northwest Women's and Children's Hospital
| | - Jin-Zhen Guo
- Department of Neonatal Intensive Care Unit, The Northwest Women's and Children's Hospital, Xi’an, Shanxi, China
| | - An-Peng Zhang
- Department of Pediatrics, The Northwest Women's and Children's Hospital
| | - Qing-Hong Li
- Department of Neonatal Intensive Care Unit, The Northwest Women's and Children's Hospital, Xi’an, Shanxi, China
| |
Collapse
|
7
|
Liu SQ, Lv Y, Fang Y, Luo RX, Zhao JR, Luo RG, Li YM, Zhang J, Zhang PF, Guo JZ, Li QH, Han MX. Magnetic compression for anastomosis in treating an infant born with long-gap oesophageal atresia: A case report. Medicine (Baltimore) 2020; 99:e22472. [PMID: 33080683 PMCID: PMC7571919 DOI: 10.1097/md.0000000000022472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Neonatal long-gap esophageal atresia (LGEA) with tracheoesophageal fistula (TEF) is an uncommon but serious congenital malformation of the esophagus in newborns, and it remains challenging for pediatric surgeons. Magnetic compress has been shown to be effective for the treatment of LGEA in children and adults. However, the implementation of this unique technique for neonatal LGEA has not been evaluated. PATIENT CONCERNS A female infant was born at 37 weeks of gestation. Prenatal ultrasound imaging revealed signs of esophageal atresia, including the absence of the gastric bubble and polyhydramnios. DIAGNOSES A diagnosis of LGEA with TEF was confirmed at birth by contrast X-ray. INTERVENTIONS She was treated with magnetic compression anastomosis (MCA) following an esophago-esophagostomy. Two magnetic rings were customized, and the MCA was conducted during the same stage surgery of ligating the TEF. Under the magnetic force, the 2 magnet rings pulled along the gastric tube to achieve anastomosis. The postoperative permanent suction of these 2 pouches was instituted, and spontaneous growth was awaited. Magnet removal was performed at 36 days, and enteral nutrition was continued via a gastric tube for 4 weeks at post-operation. OUTCOMES The upper gastrointestinal contrast confirmed the anastomotic patency perfectly after 3 months. The patient was followed up for 18 months, and exhibited durable esophageal patency without dysphagia. LESSONS These results suggest that MCA is feasible and effective for treating LGEA in infants.
Collapse
Affiliation(s)
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University
| | | | - Rui-Xue Luo
- Northwest Institute for Nonferrous Metal Research (NIN)
| | | | | | | | | | | | - Jin-Zhen Guo
- Department of Neonatal Intensive Care Unit, The Northwest Women's and Children's Hospital, Xi’an, Shanxi, China
| | - Qing-Hong Li
- Department of Neonatal Intensive Care Unit, The Northwest Women's and Children's Hospital, Xi’an, Shanxi, China
| | | |
Collapse
|
8
|
Matsuura R, Ueno T, Tazuke Y, Tanaka N, Yamanaka H, Takama Y, Nakahata K, Yamamichi T, Maeda N, Osuga K, Yamanouchi E, Okuyama H. Magnetic compression anastomosis for postoperative biliary atresia. Pediatr Int 2017. [PMID: 28626977 DOI: 10.1111/ped.13295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report a case of successful magnetic compression anastomosis (MCA) for obstructed cyst-jejunostomy in a young woman who had undergone surgery for type 1 biliary atresia (BA) on day 78 of life. A 16-year-old girl was admitted with obstructive jaundice. Jaundice resolved with percutaneous trans-hepatic cholangiodrainage (PTCD) but contrast medium injected from the PTCD tube did not flow through the anastomosis. Magnets were placed on each side of the anastomosis, in the cyst and the jejunum, to compress the partition. On postoperative day (POD) 6, the anastomosis was recanalized and the PTCD tube placed trans-anastomotically until POD 245. The patient remained free from jaundice after removal of the PTCD tube. MCA can be a useful and less invasive procedure for treating biliary tract anastomotic obstruction in patients with BA.
Collapse
Affiliation(s)
- Rei Matsuura
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takehisa Ueno
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Natsumi Tanaka
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiroaki Yamanaka
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichi Takama
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kengo Nakahata
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Taku Yamamichi
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Noboru Maeda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Keigo Osuga
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Eigoro Yamanouchi
- Department of Radiology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| |
Collapse
|
9
|
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.
Collapse
Affiliation(s)
- Sung Ill Jang
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | | | | |
Collapse
|
10
|
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.
Collapse
|