Technique and safety of magnetic anastomoses

Abstract

Aims: In the last few years many clinical studies were published examining a new technique of creating anastomoses, namely using magnets to perform different anastomoses (e.g. gastroenterostomy or bilioenterostomy). Our group examined the technical execution and safety of endoscopic gastroenteric anastomosis using magnets (EGAM) and the technique with a new potential therapeutic use of magnets for treating Zenker's diverticulum. Materials and methods: The EGAM procedures were performed with endoscopic and fluoroscopic guidance on biogenic specimen taken from slaughtered domestic pigs. Two coated rare-earth magnets (NdFeB, magnetic remanency: 1.2 Tesla, H: 5mm, D: 10mm) were introduced perorally by guide wires and duodenal probes. The first was positioned in the first jejunal loop, the second in the stomach, and finally they were matted transmurally to create EGAM. To examine the safety of magnetic anastomoses, another experiment was performed in male Whistar rats. The magnets (H: 1mm, D: 1mm) were surgically placed into the digestive tract to make gastroenteric anastomosis. The rats were monitored by fluoroscope and the anastomoses were examined histologically. Performing the experimental intervention on biogenic model to treat Zenker's diverticulum the first magnet (H: 40mm, D: 8mm) was placed into the diverticulum, the second one into the esophagus and they were matted through the septum including the cricopharyngeal muscle. Results: The technique of making EGAM was easy and rapid to carry out. Thus these interventions probably will not need any anesthesia. The anastomoses in the rats were developed by the 7th-10th postoperative day. There was no leakage and the adhesion was wide enough, but the magnets were damaged by the gastric acid. The experiment of treating Zenker's diverticulum was performed successfully and in our opinion it could be a new indication of using magnets. Conclusions: EGAM is safe enough to create anastomosis. More animal investigations are needed to find the ideal power and shape of magnets. To protect the magnets it may be necessary to cover them with some material, e.g. silicon.