Magnetic compression for anastomosis in treating an infant born with long-gap oesophageal atresia

Abstract

Rationale: Neonatal long-gap esophageal atresia (LGEA) with tracheoesophageal fistula (TEF) is an uncommon but serious congenital malformation of the esophagus in newborns, and it remains challenging for pediatric surgeons. Magnetic compress has been shown to be effective for the treatment of LGEA in children and adults. However, the implementation of this unique technique for neonatal LGEA has not been evaluated. Patient concerns: A female infant was born at 37 weeks of gestation. Prenatal ultrasound imaging revealed signs of esophageal atresia, including the absence of the gastric bubble and polyhydramnios. Diagnoses: A diagnosis of LGEA with TEF was confirmed at birth by contrast X-ray. Interventions: She was treated with magnetic compression anastomosis (MCA) following an esophago-esophagostomy. Two magnetic rings were customized, and the MCA was conducted during the same stage surgery of ligating the TEF. Under the magnetic force, the 2 magnet rings pulled along the gastric tube to achieve anastomosis. The postoperative permanent suction of these 2 pouches was instituted, and spontaneous growth was awaited. Magnet removal was performed at 36 days, and enteral nutrition was continued via a gastric tube for 4 weeks at post-operation. Outcomes: The upper gastrointestinal contrast confirmed the anastomotic patency perfectly after 3 months. The patient was followed up for 18 months, and exhibited durable esophageal patency without dysphagia. Lessons: These results suggest that MCA is feasible and effective for treating LGEA in infants.

Esophageal Magnetic Compression Anastomosis in Esophageal Atresia Repair: A PRISMA-Compliant Systematic Review and Comparison with a Novel Approach

“…Unfortunately, this procedure was associated with a high number of anastomotic strictures requiring repetitive dilatations [ 8 ]. Since then, a small number of case reports and case series have been published using these original, and other, magnets [ 9 , 10 , 11 , 12 , 13 ].…”

Esophageal magnetic compression anastomosis in dogs

“…One clinical report showed that anastomosis was achieved in an average of 6 d (range 3 to 7 d) in 5 patients (age 6 mo to 5.9 years) with severe recurrent postsurgical esophageal stenosis refractory to dilatation[ 25 ]. Another MCA was achieved on day 36[ 26 ]. Clinical reports have shown that the anastomosis time ranges from 3 d to 36 d[ 26 - 28 ].…”

“…Another MCA was achieved on day 36[ 26 ]. Clinical reports have shown that the anastomosis time ranges from 3 d to 36 d[ 26 - 28 ]. It involves many factors, such as the age of the child, type of EA, size of the magnetic ring and field strength of the magnetic device.…”

Endoscopic magnetic compression stricturoplasty for congenital esophageal stenosis: A case report

“…MCA has been used for minimally invasive cardiac bypass surgery[ 9 , 10 ] and for the treatment of biliary obstruction after liver transplantation[ 5 , 11 - 13 ]. In recent years, in addition to the application of MCA in gastrointestinal anastomosis[ 14 - 17 ], rectum atresia, and colorectal stricture in children[ 4 , 16 , 18 , 19 ], more clinical studies have been reported on its application in refractory stricture after esophageal atresia (EA). Zaritzky et al [ 18 ] showed that MCA achieved esophageal reanastomosis within 6 d in infants with EA who had primary or secondary anastomotic stenosis.…”