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World Journal of Surgery

, Volume 42, Issue 12, pp 4039–4045 | Cite as

Magnetic Anastomosis for Biliojejunostomy: First Prospective Clinical Trial

  • Xue-Min Liu
  • Xiao-Peng Yan
  • Hong-Ke Zhang
  • Feng Ma
  • Yan-Guang Guo
  • Chao Fan
  • Shan-Pei Wang
  • Ai-Hua Shi
  • Bo Wang
  • Hao-Hua Wang
  • Jian-Hui Li
  • Xiao-Gang Zhang
  • Rongqian Wu
  • Xu-Feng ZhangEmail author
  • Yi LvEmail author
Original Scientific Report with Video

Abstract

Background

Magnetic compression anastomosis (magnamosis, MCA) has been verified safe and effective by us and others in animal bilioenteric anastomosis (BEA). The objective of the present study was to introduce clinical application of magnetic compression bilioenteric anastomosis (MC-BEA) with a unique device in series of patients.

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

Forty-one patients were included. Thirty-four (82.9%) patients had a malignant primary disease, while seven (17.1%) had benign disease. The median time for MC-BEA was 10.5 min (interquartile range [IQR] 8.3–13.0 min). No perioperative morbidity or mortality associated with 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 two (4.9%) developed anastomotic stricture at 4 months and 14 months after surgery, and underwent reoperation for reconstruction of BEA.

Conclusions

MCA is a safe, effective, and time-saving modality for biliojejunostomy.

Notes

Acknowledgements

The authors thank Dr. Zhi-Min Geng, Dr. Xue Yang and other collaborators in Department of Hepatobiliary Surgery for the technical support in surgery; Dr. Rui-Xue Luo in Northwest Institute for Non-ferrous Metal Research, and Dr. Di-Chen Li in the Mechanical Engineering Department of Xi’an Jiaotong University for their support in machining and mechanical property test of the magnets.

Funding

National Natural Science Foundation of China (30830099, 81470896, 81127005).

Compliance with ethical standards

Conflict of interest

All authors declare that they have no disclosures to report.

Supplementary material

Supplementary material 1 (WMV 8247 kb)

References

  1. 1.
    Avaliani M, Chigogidze N, Nechipai A et al (2009) Magnetic compression biliary-enteric anastomosis for palliation of obstructive jaundice: initial clinical results. J Vasc Interv Radiol 20:614–623CrossRefGoogle Scholar
  2. 2.
    Reid-Lombardo KM, Ramos-De la Medina A, Thomsen K et al (2007) Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J Gastrointest Surg 11:1704–1711CrossRefGoogle Scholar
  3. 3.
    Zhu JQ, Li XL, Kou JT et al (2017) Bilioenteric anastomotic stricture in patients with benign and malignant tumors: prevalence, risk factors and treatment. Hepatobiliary Pancreat Dis Int 16:412–417CrossRefGoogle Scholar
  4. 4.
    Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688CrossRefGoogle Scholar
  5. 5.
    Cantillon-Murphy P, Cundy TP, Patel NK et al (2015) Magnets for therapy in the GI tract: a systematic review. Gastrointest Endosc 82:237–245CrossRefGoogle Scholar
  6. 6.
    Obora Y, Tamaki N (1978) Matsumoto S Nonsuture microvascular anastomosis using magnet rings: preliminary report. Surg Neurol 9:117–120PubMedGoogle Scholar
  7. 7.
    Zaritzky M, Ben R, Zylberg GI et al (2009) Magnetic compression anastomosis as a nonsurgical treatment for esophageal atresia. Pediatr Radiol 39:945–949CrossRefGoogle Scholar
  8. 8.
    Bouchard S, Huberty V, Blero D et al (2015) Magnetic compression for treatment of large oesophageal diverticula: a new endoscopic approach for a risky surgical disease? Gut 64:1678–1679CrossRefGoogle Scholar
  9. 9.
    van Hooft JE, Vleggaar FP, Le Moine O et al (2010) Endoscopic magnetic gastroenteric anastomosis for palliation of malignant gastric outlet obstruction: a prospective multicenter study. Gastrointest Endosc 72:530–535CrossRefGoogle Scholar
  10. 10.
    Graves CE, Co C, Hsi RS et al (2017) Magnetic compression anastomosis (magnamosis): first-in-human trial. J Am Coll Surg 225:676–681CrossRefGoogle Scholar
  11. 11.
    Takao S, Matsuo Y, Shinchi H et al (2001) Magnetic compression anastomosis for benign obstruction of the common bile duct. Endoscopy 33:988–990CrossRefGoogle Scholar
  12. 12.
    Muraoka N, Uematsu H, Yamanouchi E et al (2005) Yamanouchi magnetic compression anastomosis for bilioenteric anastomotic stricture after living-donor liver transplantation. J Vasc Interv Radiol 16:1263–1267CrossRefGoogle Scholar
  13. 13.
    Jang SI, Rhee K, Kim H et al (2014) Recanalization of refractory benign biliary stricture using magnetic compression anastomosis. Endoscopy 46:70–74PubMedGoogle Scholar
  14. 14.
    Jang SI, Choi J, Lee DK (2015) Magnetic compression anastomosis for treatment of benign biliary stricture. Dig Endosc 27:239–249CrossRefGoogle Scholar
  15. 15.
    Matsuno N, Uchiyama M, Nakamura Y et al (2009) A nonsuture anastomosis using magnetic compression for biliary stricture after living donor liver transplantation. Hepatogastroenterology 56:47–49PubMedGoogle Scholar
  16. 16.
    Parlak E, Koksal AS, Kucukay F et al (2017) A novel technique for the endoscopic treatment of complete biliary anastomosis obstructions after liver transplantation: through-the-scope magnetic compression anastomosis. Gastrointest Endosc 85:841–847CrossRefGoogle Scholar
  17. 17.
    Cope C (1995) Evaluation of compression cholecystogastric and cholecystojejunal anastomoses in swine after peroral and surgical introduction of magnets. J Vasc Interv Radiol 6:546–552CrossRefGoogle Scholar
  18. 18.
    Saito R, Tahara H, Shimizu S et al (2017) Biliary-duodenal anastomosis using magnetic compression following massive resection of small intestine due to strangulated ileus after living donor liver transplantation: a case report. Surg Case Rep 3:73CrossRefGoogle Scholar
  19. 19.
    Fan C, Ma J, Zhang HK et al (2011) Sutureless intestinal anastomosis with a novel device of magnetic compression anastomosis. Chin Med Sci J 26:182–189CrossRefGoogle Scholar
  20. 20.
    Fan C, Yan XP, Liu SQ et al (2012) Roux-en-Y choledochojejunostomy using novel magnetic compressive anastomats in canine model of obstructive jaundice. Hepatobiliary Pancreat Dis Int 11:81–88CrossRefGoogle Scholar
  21. 21.
    Fan C, Zhang H, Yan X et al (2017) Advanced Roux-en-Y hepaticojejunostomy with magnetic compressive anastomats in obstructive jaundice dog models. Surg Endosc 32:779–789CrossRefGoogle Scholar
  22. 22.
    Li JH, Guo L, Yao WJ et al (2014) Healing of stoma after magnetic biliary-enteric anastomosis in canine peritonitis models. Chin Med Sci J 29:91–97CrossRefGoogle Scholar
  23. 23.
    Liu SQ, Lei P, Cao ZP et al (2012) Nonsuture anastomosis of arteries and veins using the magnetic pinned-ring device: a histologic and scanning electron microscopic study. Ann Vasc Surg 26:985–995CrossRefGoogle Scholar
  24. 24.
    Liu SQ, Lei P, Cui XH et al (2013) Sutureless anastomoses using magnetic rings in canine liver transplantation model. J Surg Res 185:923–933CrossRefGoogle Scholar
  25. 25.
    Wang SP, Yan XP, Xue F et al (2015) Fast magnetic reconstruction of the portal vein with allogeneic blood vessels in canines. Hepatobiliary Pancreat Dis Int 14:293–299CrossRefGoogle Scholar
  26. 26.
    Xue F, Guo HC, Li JP et al (2016) Choledochojejunostomy with an innovative magnetic compressive anastomosis: how to determine optimal pressure? World J Gastroenterol 22:2326–2335CrossRefGoogle Scholar
  27. 27.
    Xue F, Li J, Lu J et al (2016) Splenorenal shunt via magnetic compression technique: a feasibility study in canine and cadaver. Minim Invasive Ther Allied Technol 25:329–336CrossRefGoogle Scholar
  28. 28.
    Yan X, Fan C, Ma J et al (2013) Portacaval shunt established in six dogs using magnetic compression technique. PLoS ONE 8:e76873CrossRefGoogle Scholar
  29. 29.
    Yan XP, Liu WY, Ma J et al (2015) Extrahepatic portacaval shunt via a magnetic compression technique: a cadaveric feasibility study. World J Gastroenterol 21:8073–8080CrossRefGoogle Scholar
  30. 30.
    Zhang H, Tan K, Fan C et al (2017) Magnetic compression anastomosis for enteroenterostomy under peritonitis conditions in dogs. J Surg Res 208:60–67CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Xue-Min Liu
    • 1
    • 2
  • Xiao-Peng Yan
    • 1
    • 2
  • Hong-Ke Zhang
    • 1
    • 2
  • Feng Ma
    • 1
    • 2
  • Yan-Guang Guo
    • 1
    • 2
  • Chao Fan
    • 1
    • 2
  • Shan-Pei Wang
    • 1
    • 2
  • Ai-Hua Shi
    • 2
  • Bo Wang
    • 1
    • 2
  • Hao-Hua Wang
    • 1
    • 2
  • Jian-Hui Li
    • 1
    • 2
  • Xiao-Gang Zhang
    • 1
    • 2
  • Rongqian Wu
    • 2
  • Xu-Feng Zhang
    • 1
    • 2
    Email author
  • Yi Lv
    • 1
    • 2
    Email author
  1. 1.Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and EngineeringThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anPeople’s Republic of China
  2. 2.Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research CenterXi’anPeople’s Republic of China

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