Endoscopy 2021; 53(12): E437-E439
DOI: 10.1055/a-1322-1899
E-Videos

Endoscopy-assisted magnetic compression anastomosis for rectal anastomotic atresia

Guifang Lu*
1  Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P. R. China
,
Jing Li*
1  Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P. R. China
,
Mudan Ren
1  Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P. R. China
,
Feng Ma
2  National and Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P. R. China
,
Xuejun Sun
3  Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P. R. China
,
Yi Lv
4  Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P. R. China
,
Shuixiang He
1  Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, P. R. China
› Author Affiliations
 

Magnetic compression anastomosis (MCA) has been used to achieve anastomotic recanalization to treat severe stenosis or atresia of the biliary tract and digestive tract [1] [2] [3] [4]. Herein, we report successful recanalization by means of MCA in a case of rectal anastomotic atresia.

A 60-year-old man who had undergone radical resection combined with double-lumen ileostomies for rectal carcinoma 1 year ago, and was scheduled to undergo stoma closure surgery 3 months ago, was admitted to our hospital with anastomotic atresia, where the anastomosis was completely obstructed by regenerated scar tissue. Anastomotic atresia 5 cm in length was confirmed under colonoscopy and meglumine diatrizoate radiography ([Fig. 1]).

Zoom Image
Fig. 1 Rectal anastomotic atresia 5 cm in length: a colonoscopy, b meglumine diatrizoate radiography.

After the patient had given signed informed consent and undergone preoperative examination and general anesthesia, endoscopy-assisted rectal MCA was performed, lasting 1.5 h ([Fig. 2]). The enteroscope with the magnetic ring attached to it was passed in a retrograde manner from the terminal ileum to the blind end of the anastomotic stoma, where the magnetic ring was released. Then another magnetic ring was passed by hand through the anus to the anastomosis. The two magnetic rings were attracted to each other across the anastomotic stoma. Lastly, the enteroscope was removed and C-arm radiography showed that the magnetic rings were well aligned. At 13 days after MCA, the magnetic ring complex was discharged through the anus. Anastomotic stoma recanalization with an intestinal diameter enlarged to 1 cm after balloon dilatation was confirmed by colonoscopy ([Fig. 2]).

Zoom Image
Fig. 2 Endoscopy-assisted rectal magnetic compression anastomosis and balloon dilatation. a, b Magnetic rings in place: a on the oral side, b on the anal side. c C-arm radiography shows the magnetic rings to be well-aligned. d Balloon dilation. e, f Anastomotic stoma after dilation.

After 1 month, the rectal anastomotic stoma was atresic again, and endoscopy-assisted rectal MCA was again carried out; repeat anastomotic balloon dilation with subsequent stent implantation were then performed ([Fig. 3]; [Video 1]).

Zoom Image
Fig. 3 Re-formed atresic rectal anastomotic stoma, treated by repeat magnetic compression anastomosis and balloon dilatation followed by stent implantation. a Atresic anastomotic stoma. b, c Magnetic rings in place: b on the oral side, c on the anal side. d Anastomotic stoma stenosis. e Balloon dilation. f Stent implantation.

Video 1 Endoscopy-assisted rectal magnetic compression anastomosis.


Quality:

Anastomotic stoma recanalization was confirmed by colonoscopy without resistance 7 months after the operation. Stoma-closure surgery has been performed, and normal transanal defecation has been restored ([Fig. 4]).

Zoom Image
Fig. 4 a – c Recanalized anastomotic stoma. d Patient’s abdomen after stoma closure surgery.

Endoscopy_UCTN_Code_TTT_1AQ_2AF

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Competing interests

The authors declare they have no conflict of interest.

Acknowledgments

The authors want to thank the State Key Laboratory for Mechanical Behavior of Materials, Xi’an Jiaotong University.

* Jing Li and Guifang Lu contributed equally to this article and are considered joint first authors.



Corresponding author

Shuixiang He, PhD
Department of Gastroenterology
The First Affiliated Hospital of Xi’an Jiaotong University
No. 277 Yanta West Road
Xi’an
Shaanxi 710061
P. R. China

Publication History

Publication Date:
27 January 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 Rectal anastomotic atresia 5 cm in length: a colonoscopy, b meglumine diatrizoate radiography.
Zoom Image
Fig. 2 Endoscopy-assisted rectal magnetic compression anastomosis and balloon dilatation. a, b Magnetic rings in place: a on the oral side, b on the anal side. c C-arm radiography shows the magnetic rings to be well-aligned. d Balloon dilation. e, f Anastomotic stoma after dilation.
Zoom Image
Fig. 3 Re-formed atresic rectal anastomotic stoma, treated by repeat magnetic compression anastomosis and balloon dilatation followed by stent implantation. a Atresic anastomotic stoma. b, c Magnetic rings in place: b on the oral side, c on the anal side. d Anastomotic stoma stenosis. e Balloon dilation. f Stent implantation.
Zoom Image
Fig. 4 a – c Recanalized anastomotic stoma. d Patient’s abdomen after stoma closure surgery.