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

Abstract

The use of magnet compression to endoscopically create an esophageal anastomosis is an intriguing approach to esophageal atresia repair, but published cases with an existing available device have demonstrated mixed success. One major shortcoming has been the formation of subsequent severe, recalcitrant strictures after primary repair. To address the limitations of the existing device, we recently introduced and reported success with specially designed bi-radial magnets that exhibit a novel geometry and unique tissue compression profile. The aim of this study is to compare the outcomes using our novel device (novel group, NG) with those of previous reports which utilized the historical device (historic group, HG) in a PRISMA-compliant systematic review. Seven studies were eligible for further analysis. Additionally, one of our previously unreported cases was included in the analysis. Esophageal pouch approximation prior to primary repair was performed more frequently in the NG than in the HG (100% NG vs. 21% HG; p = 0.003). There was no difference in the overall postoperative appearance of postoperative stricture (95% HG vs. 100% NG; p = 0.64). The number of postoperative dilatations trended lower in the NG (mean 4.25 NG vs. 9.5 HG; p = 0.051). In summary, magnetic compression anastomosis adds a new promising treatment option for patients with complex esophageal atresia. Prior approximation of pouches and a novel magnet design have the potential to lower the rate of stricture formation.

Magnetic Compression Anastomosis–Past Experience and Current Proposals for Further Development in Pediatric Minimally Invasive Surgery

“…Recently, other groups have been reviving MCA for use in various pediatric surgical indications [ 13 ], including esophageal atresia repair [ 11 , 12 , 27 ], rectal atresia [ 9 ], duodenal stenosis [ 10 ], vascular anastomosis [ 28 ], and for re-cannulation of the hypopharynx [ 29 ]. Several experimental studies have been conducted in swine [ 30 , 31 ], rabbits, and dogs [ 32 ].…”

“…Remarkably, the number of publications and presentations on the topic has been increasing over the past decade, especially in pediatric surgery. While this is indicative of a greater interest in the potential use of MCA, the more recent clinical applications are still limited to case presentations and small patient series [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ].…”

Beyond the gut: spectrum of magnetic surgery devices

“…The magnetic compression technique, which has been commonly used in surgical devices for the GI tract ( 18 , 55 , 56 ), is now being explored by cardiac and vascular surgeons as a way to create vascular anastomoses ( 57 – 59 ). In patients with coronary artery stenosis leading to clinically significant myocardial ischemia, conventional revascularization via bypass grafting to a separate artery requires prolonged clamping of the artery to allow for a handsewn anastomosis.…”

Repair of Complex Esophageal Atresia with Tracheobronchial Remnant using Special Magnets

“…They have been tested extensively in animal studies 3,4 before using them in select clinical cases. [5][6][7] This report discusses the technical management of a patient with esophageal atresia and distal tracheoesophageal fistula (gross type C) that was found to have a distal esophageal tracheobronchial remnant after previous ligation of the lower esophagus. This approach utilized the Connect-EA magnetic device to create an esophageal anastomosis and avoided repeated thoracic interventions.…”