Compression Anastomosis Research Articles

Long-gap esophageal atresia: management, most frequent complications, and expert recommendations – review of literature

Introduction and aim of the study. Long-gap esophageal atresia (LGEA) is a congenital anomaly in which the gap between both ends of the esophagus exceeds three intervertebral spaces and is an esophageal atresia without air in the abdomen. The defect is both therapeutic and surgical challenge. This review aims at providing an overview of the most recent literature on the effective methods for treatment of LGEA, and the most frequent complications and experts’ recommendations on this subject.
 Material and methods. The systematic review was based on available data collected using PubMed database and the Google Scholar web search engine.
 Analysis of the literature. There is no consensus on the ideal technique for surgical treatment of LGEA. There are two possible approaches for opening the thorax – thoracotomy and thoracoscopy. The techniques stimulating esophageal elongation include external and internal traction techniques, magnetic compression anastomosis and intramural botulinum type A toxin injection. Replacement methods are a viable option when it is impossible to preserve the native esophagus. Decellularized matrices seem to be promising in developing an esophageal substitute. Regardless of the surgical approach a common complication of surgical treatment is anastomotic stenosis which requires further surgical interventions.
 Conclusion. Elongation techniques are effective in approximation of the proximal and distal esophagus. The future lies with tissue engineering and inventing an off-the-shelf esophageal substitute. The centralization of treatment is recommended. After discharge from hospital interdisciplinary outpatient assessment and care is required. Further prospective studies are needed to determine the optimal mode of treatment and prevent complications associated with LGEA.

Magnetic Compression Anastomosis for Post-cholecystectomy Biliary Stricture

Magnetic Compression Anastomosis for Post-cholecystectomy Biliary Stricture

Magnetic Compression Anastomosis for Recanalization of Complete Ureteric Occlusion after Radical Cystoprostatectomy

Magnetic Compression Anastomosis for Recanalization of Complete Ureteric Occlusion after Radical Cystoprostatectomy

Recanalization by magnetic compression anastomosis for complete bile duct obstruction and retrieval of a migrated magnet.

Recanalization by magnetic compression anastomosis for complete bile duct obstruction and retrieval of a migrated magnet.

Magnetic Compression Anastomosis-Past Experience and Current Proposals for Further Development in Pediatric Minimally Invasive Surgery.

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.

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

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

Effect of ureteral stricture in transplant kidney and choice of treatment on long-term graft survival.

To explore the risk factors of ureteral stricture in transplant kidney and the clinical effects of different treatment methods. The 62 patients with transplant kidney ureteral stenosis as the experimental group, and another group of recipients from the same donor as the control group (n = 59 cases). The risk factors for ureteral stricture and the survival rate of transplant kidney were analyzed and compared. The 62 patients were divided into open operation, luminal operation, and magnetic compression anastomosis (MCA) operation group. The effect of the operation and the survival rate of transplant kidney among the three groups were compared. In our study, we found that the above differences were statistically significant in clinical data such as gender, multiple donor renal arteries, history of infection, and delayed graft function (DGF) between the two groups (P < 0.05). Urinary tract infection and DGF history were the independent risk factors for the development of ureteral stricture. The open operation had the best treatment effect and the survival rate of the transplant kidney, followed by the MCA, the stricture recurrence rate in the luminal operation was the highest. The ureteral stricture has a negative correlation with the long-term survival rate of the transplant kidney, the curative rate and long-term effect of open surgery are the best, stricture recurrence rate of luminal surgery is high, and it may require multiple operations in the future, the MCA is a new breakthrough and innovation in the treatment of ureteral stricture.

Side-to-side magnet anastomosis system duodeno-ileostomy with sleeve gastrectomy: early multi-center results

IntroductionGastrointestinal anastomoses with classical sutures and/or metal staples have resulted in significant bleeding and leak rates. This multi-site study evaluated the feasibility, safety, and preliminary effectiveness of a novel linear magnetic compression anastomosis device, the Magnet System (MS), to form a side-to-side duodeno-ileostomy (DI) diversion for weight loss and type 2 diabetes (T2D) resolution.MethodsIn patients with class II and III obesity (body mass index [BMI, kg/m2] ≥ 35.0– ≤ 50.0 with/without T2D [HbA1C > 6.5%]), two linear MS magnets were delivered endoscopically to the duodenum and ileum with laparoscopic assistance and aligned, initiating DI; sleeve gastrectomy (SG) was added. There were no bowel incisions or retained sutures/staples. Fused magnets were expelled naturally. Adverse events (AEs) were graded by Clavien-Dindo Classification (CDC).ResultsBetween November 22, 2021 and July 18, 2022, 24 patients (83.3% female, mean ± SEM weight 121.9 ± 3.3 kg, BMI 44.4 ± 0.8) in three centers underwent magnetic DI. Magnets were expelled at a median 48.5 days. Respective mean BMI, total weight loss, and excess weight loss at 6 months (n = 24): 32.0 ± 0.8, 28.1 ± 1.0%, and 66.2 ± 3.4%; at 12 months (n = 5), 29.3 ± 1.5, 34.0 ± 1.4%, and 80.2 ± 6.6%. Group mean respective mean HbA1C and glucose levels dropped to 1.1 ± 0.4% and 24.8 ± 6.6 mg/dL (6 months); 2.0 ± 1.1% and 53.8 ± 6.3 mg/dL (12 months). There were 0 device-related AEs, 3 procedure-related serious AEs. No anastomotic bleeding, leakage, stricture, or mortality.ConclusionIn a multi-center study, side-to-side Magnet System duodeno-ileostomy with SG in adults with class III obesity appeared feasible, safe, and effective for weight loss and T2D resolution in the short term.

Side-to-side duodeno-ileal magnetic compression anastomosis: design and feasibility of a novel device in a porcine model.

Minimally invasive metabolic/bariatric surgery (MBS) may be further advanced by magnetic compression anastomosis (MCA) technology. The study aimed to develop a magnet sized to create a patent duodeno-ileostomy (DI) and verify its effectiveness in a porcine model. Developmental study phase: magnets with 4 different flange-offset dimensions were tested to identify a design that would successfully form a compression anastomosis. Verification phase: evaluation of the selected design's efficacy. In each 6-week phase (4 pigs/phase), one magnet was inserted laparoscopically in the jejunum, one placed gastroscopically in the duodenum. Magnets were aligned, gradually fused, formed an anastomosis, and then detached and were expelled. At necropsy, MCA sites and sutured enterotomy sites were collected and compared. Developmental phase: the linear BC42 magnet with a 2.3-mm flange offset design was selected. Verification phase: in 4 swine magnets were mated at the target location, confirmed radiographically. Mean time to magnet detachment 16.0days (12-22), to expulsion 24.5days (17-33). MCA was achieved in all animals at time of sacrifice. Animals gained a mean 9.5kg (3.9-11.8). Specimens revealed patent anastomoses of ≥ 20mm with smooth mucosa and minimal inflammation and fibrosis compared to sutured enterotomies. One pig underwent corrective surgery for a mesenteric hernia without sequelae. In a large-animal model, gross and histopathologic examination confirmed that the linear MCA device created a patent, well-vascularized, duodeno-ileal anastomosis. The novel MCA device may be appropriate for use in human MBS procedures.

Compression anastomoses in colon surgery (literature review)

А review of domestic and foreign literature on compression methods for the formation of colonic anastomoses is presented in the paper. Despite advances in the improvement of the manual suture of the colon, the frequency of postoperative complications remains high – 68.7%, while mortality ranges from 1% to 26%. Thus, it was not possible to achieve the absolute reliability of the traditional manual suture in the formation of colonic anastomoses. Compression anastomosis has an advantage over manual. When forming an anastomosis using a compression method, a decrease in time was noted, ease of creating an anastomosis, a significant decrease in postoperative complications and a high quality of the formed anastomoses, confirmed by morphological studies.

A Preclinical Study of an Esophagojejunal Compression Anastomosis After Total Gastrectomy with Self-Forming Magnets

A Preclinical Study of an Esophagojejunal Compression Anastomosis After Total Gastrectomy with Self-Forming Magnets

Clinical effect of magnetic compression anastomosis on ureterostenosis after kidney transplantation.

Clinical effect of magnetic compression anastomosis on ureterostenosis after kidney transplantation.

Abstract No. 99 Magnetic Compression Anastomosis for Untreatable Luminal Occlusions: Early Experience of a Novel Minimally Invasive Image-Guided Approach

Abstract No. 99 Magnetic Compression Anastomosis for Untreatable Luminal Occlusions: Early Experience of a Novel Minimally Invasive Image-Guided Approach

Establishment of Yan-Zhang Staging of Digestive Tract Magnetic Compression Anastomosis in a Rat Model

INTRODUCTION: Magnetic compression anastomosis (magnamosis), is a safe and feasible method for gastrointestinal anastomosis. However, the pathological process involved in magnamosis of the digestive tract has not been investigated. This study aimed to establish the stages of digestive tract magnamosis in a rat model. METHODS: Eighty-four Sprague-Dawley albino rats (200-250 g) were randomly divided into 14 groups (n = 6 per group). All rats underwent colonic magnamosis. Starting from postoperative day (POD) 1, 1 group of rats was sacrificed every other day to obtain the specimens. Burst pressure at the anastomotic site of each specimen was examined. Gross and histological examination of the anastomotic site of each specimen was performed to establish the stages of the digestive tract magnamosis. RESULTS: Colonic magnamosis was successfully performed in all rats and the mean anastomosis time was 5.62 ± 0.91 minutes. The postoperative survival rate was 100%. The lowest anastomotic burst pressure was 78.33 ± 3.44 mmHg on POD3. The anastomotic burst pressure gradually increased and stabilized on POD21. Macroscopic and histological examination showed that the anastomotic mucosal and serosal layer did not heal on POD1. The serosal layer of the anastomosis healed by adhesion on POD3, and the mucosal layer began to heal on POD3-11 and was established by POD21. CONCLUSION: According to the anastomotic bursting pressure, gastrointestinal magnamosis can be divided into the magnetic maintenance, fragile, strengthening, and stable period, which correspond to serosal adhesion formation, serosal healing, mucosal healing, and stereotyping, respectively, based on histological changes.

Esophageal magnetic compression anastomosis in dogs.

BACKGROUNDMagnetic compression anastomosis (MCA) is a novel suture-free reconstruction of the digestive tract. It has been used in gastrointestinal anastomosis, jejunal anastomosis, cholangioenteric anastomosis and so on. The traditional operative outcomes of congenital esophageal atresia and benign esophageal stricture are poor, and there are too many complications postoperatively.AIMTo test MCA technology to reconstruct the esophagus in dogs, prior to studying the feasibility and safety of MCA in humans.METHODSThirty-six dogs were randomized into either the study or control group (n = 18 per group). The dogs in the study group were subjected to end-to-end esophageal anastomosis with the magnetic compression device, while those in the control group underwent hand-sewn anastomosis with 4-0 absorbable multifilament Vicryl. We used interrupted single-layer inverting sutures. The anastomosis time, gross appearance, weight and pathology of the anastomosis were evaluated at one month, three months and six months postoperatively.RESULTSThe anastomosis time of the MCA group was shorter than that of the hand-sewn group (7.5 ± 1.0 min vs 12.5 ± 1.8 min, P < 0.01). In the MCA group, X-ray examination was performed every day to locate the magnetic device in the esophagus before the magnetic device fell off from the esophagus. In the hand-sewn group, dogs did not undergo X-ray examination. One month after the surgeries, the mean weight of the dogs in the hand-sewn group had decreased more than that of the dogs in the MCA group (11.63 ± 0.71 kg vs 12.73 ± 0.80 kg, P < 0.05). At 3 mo and 6 mo after the operation, the dogs’ weights were similar between the two groups (13.75 ± 0.84 kg vs 14.03 ± 0.82 kg, 14.93 ± 0.80 kg vs 15.44 ± 0.47 kg). The number of inflammatory cells in MCA group was lower than that in hand-sewn group on 1 mo after operation.CONCLUSIONMCA is an effective and safe method for esophageal reconstruction. The anastomosis time of the MCA group was less than that of the hand-sewn group. This study shows that MCA technology may be applied to human esophageal reconstruction, provided these favorable results are confirmed by more publications.

Design and pre-clinical evaluation of a folding magnetic anastomosis device for minimally invasive surgery

Objective: This work presents the results of Benchtop tests and pre-clinical study of a novel design for a foldable magnetic anastomosis device. The device can be deployed through an endoscope device channel and fold into a ring larger than the deployment port. This new design enables the target application in JJ-anastomosis creation. Material and methods: The folding anastomosis device is constructed from a chain of permanent magnets suspended in a suture weaving inspired by the contact-aided compliant mechanisms. The device was deployed through an endoscope in Benchtop experiments and its expected coupling force was measured in a pull test. A set of experiments was executed during the pre-clinical study, where the device was deployed in the abdomen, to estimate the reliability of deployment and the plausibility of the use in jejuno-jejunal (JJ)- and gastrojejunal (GJ)-anastomosis creation. Results: The presented folding anastomosis device was shown to deploy through an endoscope device channel and a catheter with an inner diameter of 3.2 mm. After deployment the device folds reliably into a ring with an outer diameter of 7–8 mm. The folded device was shown to exhibit a coupling force comparable to similar cases of JJ-anastomosis creation. It is concluded that the presented design of a folding magnetic ring is suitable for select cases of magnetic compression anastomosis where the device is either delivered through a catheter to fold into an anastomosis ring larger than the deployment port or through an endoscopes device channel to allow for convenient visual confirmation of the device during placement.

Esophageal Magnetic Compression Anastomosis in Esophageal Atresia Repair: A PRISMA-Compliant Systematic Review and Comparison with a Novel Approach.

The use of magnet compression to endoscopically create an esophageal anastomosis is an intriguing approach to esophageal atresia repair, but published cases with an existing available device have demonstrated mixed success. One major shortcoming has been the formation of subsequent severe, recalcitrant strictures after primary repair. To address the limitations of the existing device, we recently introduced and reported success with specially designed bi-radial magnets that exhibit a novel geometry and unique tissue compression profile. The aim of this study is to compare the outcomes using our novel device (novel group, NG) with those of previous reports which utilized the historical device (historic group, HG) in a PRISMA-compliant systematic review. Seven studies were eligible for further analysis. Additionally, one of our previously unreported cases was included in the analysis. Esophageal pouch approximation prior to primary repair was performed more frequently in the NG than in the HG (100% NG vs. 21% HG; p = 0.003). There was no difference in the overall postoperative appearance of postoperative stricture (95% HG vs. 100% NG; p = 0.64). The number of postoperative dilatations trended lower in the NG (mean 4.25 NG vs. 9.5 HG; p = 0.051). In summary, magnetic compression anastomosis adds a new promising treatment option for patients with complex esophageal atresia. Prior approximation of pouches and a novel magnet design have the potential to lower the rate of stricture formation.

Establishment of Yan-Zhang's staging of digestive tract magnetic compression anastomosis in a rat model

Magnetic compression anastomosis, also known as magnamosis, is a safe and feasible method for digestive tract anastomosis. However, the pathological process involved in magnamosis of the digestive tract has not been investigated. This study aimed to establish the stages of digestive tract magnamosis in a rat model. Eighty-four Sprague–Dawley albino rats (200–250 g) were randomly divided into 14 groups (n = 6 per group). All rats underwent colonic magnamosis. Starting from postoperative day (POD) 1, one group of rats was sacrificed every other day to obtain the specimens. Burst pressure at the anastomotic site of each specimen was examined. Gross and histological examination of the anastomotic site was performed to establish the stages of the digestive tract magnamosis. Colonic magnamosis was successfully performed in all rats and the mean anastomosis time was 5.62 ± 0.91 min. The postoperative survival rate was 100%. The lowest anastomotic burst pressure was 78.33 ± 3.44 mmHg on POD3. The anastomotic burst pressure gradually increased and stabilized on POD21. Macroscopic and histological examination showed that the anastomotic mucosal and serosal layer did not heal on POD1. The serosal layer of the anastomosis healed by adhesion on POD3, and the mucosal layer began to heal on POD3-11 and was established by POD21. According to the anastomotic bursting pressure, digestive tract magnamosis can be staged into the magnetic maintenance, fragile, strengthening, and stable phases, which on histology correspond to the serosal adhesion formation, serosal healing, mucosal healing, and stereotyping, respectively.

Compression anastomoses in the surgical treatment of patients with diseases of the gastrointestinal tract

The results of a study of titanium nickelide devices used for the formation of compression anastomoses in patients with digestive system diseases and describes the techniques of compression fistula formation using these devices has been presented. Besides, the paper presents clinical experience in the formation of anastomoses between the organs of gastrointestinal tract for the treatment of 96 patients with various pathologies of digestive organs. 116 compression anastomoses were applied in our clinic. Anastomotic dehiscence was found in three cases (2,6%) which are described in details in the article. In all patients, the devices evacuated from the digestive tract in a natural way for 14 days. Fibrotic scope examination performed after an operation showed that created anastomoses corresponded to the dimensions of used structures. A soft scar by primary healing type was formed on the parts with compression anastomosis. Using titanium nickelide devices for the formation of compression anastomoses between the gastrointestinal organs will improve the quality of fistula formation, reduce mortality and postoperative complications.

Usage of shape memory implants in the formation of interstitial anastomoses in the experiment

The purpose of the study was to study in an experiment the advantages of creating interintestinal anastomoses using a construction with thermomechanical memory made of titanium nickelide in comparison with the classical method of imposing interintestinal anastomoses. The work was carried out on mongrel dogs by the method of performing compression and ligature interintestinal anastomoses. The tissue response in the area of interintestinal anastomosis was studied by the authors and confirmed by histological studies. In the studied tissues of the compression interintestinal anastomosis, microscopically, the indicators of the reactive inflammatory process were less pronounced and, ultimately, no dystrophic changes and tissue nutritional disorders were found in the test material. The healing of the intestinal mucosa was significantly better than in the classical ligature anastomosis. On the basis of the experimental data obtained by us, it was concluded that the use of compression interintestinal anastomoses for the purpose of creating anastomoses occurs with the best conditions for wound healing at the site of imposition of the performed anastomosis, in contrast to the classical ligature anastomosis.