Using External Magnet Guidance and Endoscopically Placed Magnets to Create Suture-free Gastro-enteral Anastomoses

PURPOSE: To facilitate endolumenal and natural orifice procedures, we evaluated a novel technique using external and endoscopically placed magnets in forming suture-free gastro-enteral anastomoses.

METHODS: Seven anesthetized adult swine underwent endoscopic placement of differently sized magnets into the small bowel and stomach. Using external magnets, the endoscopically placed internal magnets were brought into opposition under endoscopic view. After 1 to 2 weeks, the pigs were sacrificed and analyzed. At laparotomy and under sterile conditions, peritoneal cultures were taken. The anastomoses were evaluated endoscopically and tested using the air insufflation test. Finally, the anastomoses were resected and evaluated microscopically.

RESULTS: Average operative time for endoscopic placement of magnets in small bowel and stomach in 7 swine was 34.3 +/- 14.8 minutes. Within the initial set of pigs, one pig did not form an anastomosis due to the magnets being too large to pass through the pylorus at the time of attempted magnet placement. Another pig’s post-operative course involved constipation for several days requiring additional fluids and fiber supplementation. Despite normal physical exam and activity, radiologically, the pig was determined to experience an ileus without evidence of obstruction. Upon laparotomy, the anastomosis between stomach and small bowel involved the colon without adhesions, obstruction, leak, infection or abscess. The peritoneal culture was negative. Due to these complications, our magnet size was decreased and our technique altered to include 2 external magnets, first, attracting the small bowel and stomach to the anterior abdominal wall and then bringing the 2 endolumenally placed magnets into opposition, avoiding other intra-abdominal organs. Using these alterations, 5 of 7 swine experienced uncomplicated post-operative courses forming patent, leak free (via air insufflation test), anastomoses between stomach and small bowel. All cultures were negative except one with scant growth of staphylococcus aureus and one with scant growth of coagulase negative staphylococcus, presumably both contaminants.

CONCLUSIONS: Endoscopically placed magnets with external magnet guidance are feasible and novel to forming patent gastro-enteral anastomoses without abdominal incisions or sutures. External magnetic guidance is essential for avoiding inadvertent trapping of other intra-abdominal structures.

Session: Podium Presentation

Program Number: S079

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