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An experimental study on magnetic esophageal compression anastomosis in piglets.

Authors:
Oliver J Muensterer Alexander Sterlin Christina Oetzmann von Sochaczewski Andreas Lindner Axel Heimann Alexandru Balus Jana Dickmann Maximilian Nuber Veeshal H Patel Michael A Manfredi Russell W Jennings Charles J Smithers Dario O Fauza Michael R Harrison

J Pediatr Surg 2020 Mar 11;55(3):425-432. Epub 2019 May 11.

Division of Pediatric Surgery, University of California San Francisco, San Francisco, CA, United States.

Introduction: Fashioning a patent, watertight anastomosis in patients with esophageal atresia is a challenging task in pediatric surgery, particularly when performed under tension. A reproducible suture-less alternative would decrease operative time. We evaluated magnetic esophageal compression anastomoses in a novel bypass-loop swine model.

Methods: Eight-week-old piglets underwent thoracotomy to mobilize the esophagus at the carina to create a U-shaped loop. Custom-made 8 mm diameter Neodymium Magnets were inserted into the esophagus proximal and distal to the loop, then mated side-to-side at the future anastomosis site. Pigs were observed for 8 (n = 4), 10 (n = 6), and 12 (n = 2) days and then sacrificed. The magnetic compression anastomosis was evaluated macroscopically, by radiography, burst pressure testing, and histology.

Results: All 12 pigs survived until the endpoint. Separation of the magnets occurred at a median of 9 days. Contrast esophagrams showed patency and no leak. All anastomoses withstood pressures well over 13 kPa without leak. Histopathology showed epithelialized circular scar tissue.

Conclusion: Magnetic compression anastomoses of the esophagus using our specially-designed magnets are formed between the 8th and 10th postoperative day, are patent and mechanically resistant to supraphysiologic intraluminal pressures. These data lay the basis for a potential clinical application in patients born with esophageal atresia.

Level Of Evidence: Not applicable (experimental animal study).

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http://dx.doi.org/10.1016/j.jpedsurg.2019.04.029DOI Listing
March 2020

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