Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Surg Endosc. 2010 May;24(5):1104-9. doi: 10.1007/s00464-009-0735-5. Epub 2009 Dec 24.
To facilitate endolumenal and natural orifice procedures, this study evaluated a novel technique using external and endoscopically placed magnets to create suture-free gastroenteral anastomoses.
Seven anesthetized adult swine underwent endoscopic placement of magnets into the small bowel and stomach. Using external magnets, the endoscopically placed internal magnets were brought into opposition under endoscopic view. After 1-2 weeks, the pigs were killed and analyzed. At laparotomy and under sterile conditions, peritoneal cultures were obtained. The anastomoses were evaluated endoscopically and tested using an air insufflation test. Finally, the anastomoses were resected and evaluated microscopically.
The average operative time for endoscopic placement of the magnets was 34.3 +/- 14.8 min. Successful placement and creation of anastomoses occurred in six of the pigs. One pig did not form an anastomosis because the magnets were too large to pass through the pylorus at the time of attempted magnet placement. Six swine experienced uncomplicated postoperative courses. One pig's postoperative course involved constipation for several days, requiring additional fluids and fiber supplementation. The findings at endoscopy showed that the magnets were adhered to the anastomosis, which were easily freed, or within the stomach. The air insufflation test results were negative for all the pigs. At laparotomy, there was no evidence of infection, abscess, or leak, but two peritoneal culture results were positive with scant growth of Staphylococcus aureus and coagulase-negative staphylococcus, presumably contaminants. Microscopically, the anastomoses illustrated granulation and fibrous connective tissue without evidence of infection or leak.
Endoscopically placed magnets with external magnet guidance is a feasible and novel approach to creating patent gastroenteral anastomoses without abdominal incisions or sutures.
为了便于内镜下和经自然腔道的手术，本研究评估了一种使用外部和内镜下放置的磁铁来创建无缝线的胃肠吻合术的新技术。
七只麻醉的成年猪接受了内镜下将磁铁放入小肠和胃中的操作。使用外部磁铁，在内镜下将内镜下放置的内部磁铁引入对向位置。1-2 周后，处死猪并进行分析。在剖腹手术和无菌条件下，获得腹腔培养物。通过内镜检查评估吻合口，并进行空气充气试验。最后，切除吻合口并进行显微镜检查。
内镜下放置磁铁的平均手术时间为 34.3 +/- 14.8 分钟。六只猪成功地放置和创建了吻合口。一只猪由于试图放置磁铁时磁铁太大而无法通过幽门，因此没有形成吻合口。六只猪术后恢复顺利。一只猪术后几天出现便秘，需要额外的液体和纤维补充。内镜检查发现磁铁附着在吻合口上，很容易被分离，或者在胃内。所有猪的空气充气试验结果均为阴性。剖腹探查时，没有感染、脓肿或漏的证据，但两次腹腔培养结果呈阳性，仅生长少量金黄色葡萄球菌和凝固酶阴性葡萄球菌，可能是污染物。显微镜下，吻合口显示肉芽和纤维结缔组织，没有感染或漏的证据。
内镜下放置磁铁并使用外部磁铁引导是一种可行的、新颖的方法，可以在不进行腹部切口或缝合的情况下创建通畅的胃肠吻合口。
