Clinical application of magnamosis (Magnetic Anastomosis) for Biliojejunostomy

Abstract

Background: Magnetic compression anastomosis (magnamosis, MCA) has been verified safe and effective by us and others in animal bilioenteric anastomosis (BEA). Herein, we report the first clinical study on magnetic compression bilioenteric anastomosis (MC-BEA) with a unique device. Methods: Patients with obstructive jaundice with an indication of BEA were prospectively enrolled from 2012 to 2015. After dissection of bile ducts, the mother ring and drainage tube were placed in the proximal bile duct and the purse-string suture was tightened over the drainage tube. The drainage tube was introduced into the jejunal lumen at the anastomotic site and used to guide the daughter ring to assemble with the mother ring. All the patients were routinely followed up for magnets discharge or any complications associated. Results: 41 patients were included. 34 (82.9%) patients had a malignant primary disease, while 7 (17.1%) had benign disease. 44 MC-BEA was successfully performed in all patients. The median time for MC-BEA was 10.5 min (IQR 8.3-13.0 min). No perioperative morbidity or mortality associated to MC-BEA was observed. The median time for a patent bilioenteric anastomosis formation was 19.0 days (IQR 14.5–23.0 days), and the magnets were discharged with a median postoperative duration of 35.0 days (IQR 28.0-43.0 days). With a median follow-up of 547.5 days (range 223–1042 days), no patients had biliary fistula, while 2 (4.9%) developed anastomotic stricture at 4 month and 14 month after surgery, and underwent reoperation for reconstruction of BEA. Conclusions: MCA is a safe, effective and time-saving modality for BEA.