Advanced Roux-en-Y hepaticojejunostomy with magnetic compressive anastomats in obstructive jaundice dog models

Abstract

BackgroundAlthough commonly used procedure, Roux-en-Y hepaticojejunostomy (RYHJ) remains to be complicated, time consuming, and has a relatively poor prognosis. We designed the magnetic compressive anastomats (MCAs) to perform RYHJ more efficiently and safely.Materials and methods36 dogs were divided into two groups randomly. After obstructive jaundice model construction, RYHJ was performed with MCAs in study group or by hand-sewn in control group. Both groups were followed for 1, 3, and 6 months after RYHJ. The liver function and postoperative complications were recorded throughout the follow-up. At the end of each time point, dogs were sent for magnetic resonance imaging (MRI) and sacrificed. Anastomotic samples were taken for anastomotic narrowing rate calculation, histological analyses, tensile strength testing, and hydroxyproline content testing.ResultsThe anastomotic construction times were 44.20 ± 23.02 min in study group, compared of 60.53 ± 11.89 min in control group (p < 0.05). The liver function recovered gradually after RYHJ in both groups (p > 0.05). All anastomats were expelled out of the body in 8.81 ± 2.01 days. The gross incidence of morbidity and mortality was 33.3% (6/18) and 16.7% (3/18) in study group compared with 38.9% (7/18) and 22.2% (4/18) in control group (p > 0.05), and there is no single case of anastomotic-specific complications happened in study group. The narrowing rates of anastomosis were 14.6, 18.5, and 18.7% in study group compared with 35.4, 36.9, and 34% in control group at 1st, 3rd, and 6th month after RYHJ (p < 0.05). In study group, preciser alignment of tissue layers and milder inflammatory reaction contributed to the fast and better wound healing process.ConclusionPerform RYHJ with MCAs is safer, more efficient than by hand-sewn method in obstructive jaundice dog models.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-017-5740-5) contains supplementary material, which is available to authorized users.

Magnetic compression anastomosis for biliojejunostomy and pancreaticojejunostomy in Whipple's procedure: An initial clinical study

“…Not surprisingly, a mature protocol of magnetic anastomosis allowed significant simplification for biliojejunostomy and pancreaticojejunostomy. In contrast, the median time for a hand‐sewn biliojejunostomy was around 44 min in our previous canine model . Empirically, it usually takes 20 to 30 min for an experienced surgeon to do a biliojejunostomy or pancreaticojejunostomy in our department.…”

“…Tight compression by a pair of magnets causes ischemia, necrosis and exfoliation of the interposed tissue, and simultaneous remodeling of the surrounding tissues, which finally creates recanalization of the narrowed lumen or a new anastomosis . Of note, the compressive force between the two magnets increases continuously as the interposed tissue gets thinner and thinner . Therefore, such tight compression of the two magnets largely reduces the risk of anastomotic leakage.…”

“…Perhaps not surprisingly, magnetic anastomosis avoids intima injury by needles, and subsequent inflammation caused by suture thread at anastomoses. Therefore, a sequential healing from serosa to mucosa and reconciled surrounding tissue after magnetic anastomosis contribute to the superior alignment and bridging of the tissue layers at the anastomoses . However, one patient with a primary ampullary carcinoma developed anastomotic stricture at 11 months after surgery.…”

“…However, there is no consensus of materials selection, manufacturing, and design of magnets, and the potential application of magnets remains largely unknown and thus is still being explored. During the past 15 years, we have designed different types of magnets and attempted these magnets in vascular, intestine, and biliary anastomosis in preclinical studies . In the current clinical study, we firstly introduced our newly designed magnetic devices and successfully utilized for both pancreaticojejunostomy and biliojejunostomy during Whipple's procedure.…”

“…During the past 15 years, we have designed different types of magnets and attempted these magnets in vascular, intestine, and biliary anastomosis in preclinical studies. 14,[25][26][27][28][29][30][31][32][33][34][35] In the current clinical study, we firstly introduced our newly designed magnetic devices and successfully utilized for both pancreaticojejunostomy and biliojejunostomy during Whipple's procedure.…”