Woo Russell, Wong Christopher Marc, Trimble Zachary, Puapong Devin, Koehler Shannon, Miller Scott, Johnson Sidney
1 University Of Hawaii, Honolulu, HI, USA.
2 Children's Hospital of Wisconsin, Milwaukee, WI, USA.
Surg Innov. 2017 Oct;24(5):432-439. doi: 10.1177/1553350617720994. Epub 2017 Jul 26.
Esophageal stricture is the most common complication following repair of esophageal atresia (EA). In general, these strictures are successfully managed using endoscopic techniques including bougie and balloon dilation, stenting, and chemotherapeutic agent application. If these techniques are unsuccessful, patients require segmental esophageal resection and reanastomosis or esophageal replacement. Magnetic compression anastomosis has been described in children. Herein we report our experience with magnetic compression stricturoplasty to treat refractory strictures after EA repair.
We reviewed our experience using magnets to treat refractory strictures in 2 patients. Both patients failed multiple standard interventions. Because of near complete esophageal obstruction, both patients were candidates for esophageal replacement or segmental resection/anastamosis. In both patients, we applied neodymium-iron-boron magnets using fluoroscopic and endoscopic guidance.
The magnets were successfully positioned in both cases. Magnets were left in place for 7 and 10 days allowing for gradual compression stricturoplasty/anastamosis. Upon removal of the magnets, recanalization was visualized endoscopically and self-expanding stents were placed. There were no leaks or significant early complications. By 31 months post-magnetic stricturoplasty, both patients achieved durable esophageal patency without dysphagia.
Magnetic stricturoplasty was successful at establishing early patency of the esophagus in 2 patients with recalcitrant EA strictures. Fundamental knowledge of magnetism was critical in configuring magnet arrays for surgery. In both cases, early follow-up is promising. Further follow-up will define the long-term success of this technique.
食管狭窄是食管闭锁（EA）修复术后最常见的并发症。一般来说，这些狭窄可通过包括探条和球囊扩张、支架置入以及应用化疗药物等内镜技术成功处理。如果这些技术不成功，患者则需要进行食管节段切除及再吻合或食管置换。儿童中已报道过磁性压缩吻合术。在此，我们报告我们使用磁性压缩狭窄成形术治疗EA修复术后难治性狭窄的经验。
我们回顾了使用磁体治疗2例难治性狭窄的经验。这2例患者均多次标准干预失败。由于几乎完全性食管梗阻，这2例患者均适合进行食管置换或节段切除/吻合术。在这2例患者中，我们在荧光镜和内镜引导下应用钕铁硼磁体。
2例患者磁体均成功定位。磁体留置7天和10天，以实现逐渐的压缩狭窄成形术/吻合术。磁体取出后，通过内镜观察到再通，并置入自膨式支架。未出现漏液或明显的早期并发症。至磁性狭窄成形术后31个月，2例患者均实现了持久的食管通畅且无吞咽困难。
磁性狭窄成形术成功地使2例EA难治性狭窄患者的食管早期实现了通畅。磁学基础知识对于配置手术用磁体阵列至关重要。在这2例患者中，早期随访结果令人满意。进一步随访将确定该技术的长期成功率。
