Bruns Nicholas E, Glenn Ian C, Craner Domenic R, Schomisch Steve J, Harrison Michael R, Ponsky Todd A
Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH.
Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH.
J Pediatr Surg. 2019 Mar;54(3):429-433. doi: 10.1016/j.jpedsurg.2018.09.014. Epub 2018 Sep 29.
Magnetic compression anastomosis (magnamosis) is the process of forming a sutureless anastomosis of the gastrointestinal tract using two magnetic Harrison rings. It has been shown to be effective in stomach, small bowel and colon, but has not been implemented in the esophagus. A pure esophageal atresia porcine model was developed to test the concept.
Five pigs weighing between 35 and 65 kg were used. In all pigs, a percutaneous endoscopic gastrostomy (PEG) tube was placed, and a right thoracotomy was performed. Esophageal atresia was simulated by transecting the esophagus with a cutting stapler, and magnets were placed endoscopically to approximate the two ends of the esophagus. In the first pig, the tissue within the magnetic ring was excised endoscopically to achieve immediate patency. In the second pig, approximation of the blind esophageal ends was reinforced with 3-4 externally-placed sutures but immediate patency was not performed. In the last three pigs, both external suture reinforcement and immediate patency were performed. The pigs survived for 10-14 days and received nutrition through PEG tube. At necropsy, an esophagram was performed, the specimen was explanted and a leak test was performed.
The first pig died in the early postoperative period from a leak owing to separation of the magnets. The second pig died from aspiration before the anastomosis formed. The last three pigs survived until the study endpoint. The third pig had a contained leak owing to the staple line being placed between the magnets; this was not clinically significant. The last two pigs had well-formed anastomoses. Burst tests showed no leak when injecting saline up to 30 mmHg.
Magnamosis is technically feasible for esophagoesophageal anastomoses. A survival model for pure esophageal atresia was developed and refined in pigs. Further work in this area may lead to clinical use in humans.
磁压缩吻合术（磁吻合）是使用两个磁性哈里森环形成胃肠道无缝合吻合的过程。已证明其在胃、小肠和结肠中有效，但尚未应用于食管。开发了一种单纯食管闭锁猪模型来测试该概念。
使用5头体重在35至65千克之间的猪。在所有猪中，放置经皮内镜下胃造口术（PEG）管，并进行右胸切开术。用切割吻合器横断食管模拟食管闭锁，并通过内镜放置磁体以使食管两端靠近。在第一头猪中，通过内镜切除磁环内的组织以实现即刻通畅。在第二头猪中，用3 - 4根外置缝线加强盲端食管的靠近，但未进行即刻通畅操作。在最后三头猪中，既进行了外部缝线加强又进行了即刻通畅操作。猪存活10 - 14天，并通过PEG管接受营养。尸检时，进行食管造影，取出标本并进行渗漏试验。
第一头猪术后早期因磁体分离导致渗漏而死亡。第二头猪在吻合形成前因误吸死亡。最后三头猪存活至研究终点。第三头猪因吻合钉线位于磁体之间出现局限性渗漏；这在临床上不显著。最后两头猪形成了良好的吻合口。爆破试验显示注入高达30 mmHg盐水时无渗漏。
磁吻合术在食管 - 食管吻合方面在技术上是可行的。在猪中开发并完善了单纯食管闭锁的存活模型。该领域的进一步研究可能会导致在人类中的临床应用。
