Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States; Department of Surgery, Johns Hopkins All Children's Hospital, 501 6th Ave S, Saint Petersburg, FL 33701, United States.
Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States.
J Pediatr Surg. 2022 Oct;57(10):342-347. doi: 10.1016/j.jpedsurg.2021.11.002. Epub 2021 Nov 14.
The use of magnets for the treatment of long gap esophageal atresia or "magnamosis" is associated with increased incidence of anastomotic strictures; however, little has been reported on other complications that may provide insight into refining selection criteria for appropriate use.
A single institution, retrospective review identified three cases referred for treatment after attempted magnamosis with significant complications. Their presentation, imaging, management, and outcomes were reviewed.
All three patients had prior cervical or thoracic surgery to close a tracheoesophageal fistula prior to magnamosis, creating scar tissue that can prevent magnet induced esophageal movement, leading to either magnets not attracting enough or erosion into surrounding structures. Two patients had a reported four centimeter esophageal gap prior to attempted magnamosis, both failing to achieve esophageal anastomosis, suggesting that these gaps were either measured on tension with variability in gap measurement technique, or that the esophageal segments were fixed in position from scar tissue and unable to elongate. One patient had severe tracheobronchomalacia requiring tracheostomy, with improvement in his airway after eventual tracheobronchopexies, highlighting that magnamosis does not address comorbidities often associated with this patient population.
We propose the following inclusion criteria and considerations for magnamosis: an esophageal gap truly less than four centimeters off tension with standardized measurement across centers, cautious use with a history of prior thoracic or cervical esophageal surgery, no associated tracheobronchomalacia or great vessel anomaly that would benefit from concurrent repair, and ideally to be used in centers equipped to manage potential complications.
Level IV treatment study.
使用磁铁治疗长段食管闭锁或“磁吻合术”会增加吻合口狭窄的发生率；然而，关于可能有助于完善适应证选择标准的其他并发症的报道甚少。
单中心回顾性研究确定了 3 例因尝试磁吻合术出现严重并发症而转诊的患者。对其临床表现、影像学表现、治疗方法和结局进行了回顾性分析。
所有 3 例患者在尝试磁吻合术之前均因气管食管瘘而接受过颈部或胸部手术，导致疤痕组织形成，这可能会阻碍磁铁引起的食管运动，导致磁铁吸引力不足或侵蚀到周围结构。2 例患者在尝试磁吻合术之前报告存在 4cm 的食管间隙，均未能实现食管吻合，这表明这些间隙可能是在张力下测量的，测量技术存在差异，或者食管段因疤痕组织而固定在某个位置，无法延长。1 例患者患有严重的气管支气管软化症，需要行气管造口术，最终行气管支气管固定术改善了气道，这突出表明磁吻合术并不能解决与该患者群体相关的合并症。
我们建议以下磁吻合术的纳入标准和注意事项：真正的食管间隙小于 4cm，且在各中心采用标准化测量方法；既往有胸部或颈部食管手术史时需谨慎使用；无合并气管支气管软化症或大血管异常，这些疾病不能从同期修复中获益；且理想情况下应在有能力处理潜在并发症的中心使用。
IV 级治疗研究。
