Recanalization of rectal anastomosis atresia with magnetic compression anastomosis

A 71-year-old man underwent radical resection of rectal cancer and ileostomy 11 months prior. Two weeks ago, an ileostomy closure was planned; however, a colonoscopy revealed atresia of the rectal anastomosis. The patient came to our hospital seeking a magnetic surgical treatment technique. Following colonoscopy and colonography, which clearly demonstrated rectal anastomotic atresia ([Fig. 1]), we developed a detailed treatment plan of magnetic compression anastomosis ([Fig. 2]).

Fig. 1 The atresia of the rectum. a Colonoscopy. b, c Colonography.

Fig. 2 Surgical planning. a The daughter magnet (DM) and the parent magnets (PMs) were inserted through the ileostomy and anus, respectively. b The daughter magnet and parent magnets attracted together.

The procedure was performed after the patient and his family signed the informed consent form. Following anesthesia, an endoscope was inserted into the colon through the ileostomy; however, reaching the proximal end of the atresia proved challenging. Consequently, a Zebra guidewire was introduced through the biopsy hole to navigate as close as possible to the proximal end of the atresia. The guidewire was maintained in position while the colonoscope was withdrawn. The tail end of the guidewire passed through the side hole of the daughter magnet, which was then advanced along the guidewire using the endoscope to approach the proximal end of the atresia as closely as possible. Subsequently, the guidewire and endoscope were removed ([Fig. 3]). After the daughter magnet reached the proximal end of the rectal atresia, the parent magnets were inserted through the anus to the distal end of the atresia, where the parent magnets and daughter magnet were attracted together ([Fig. 4], [Video 1]).

Fig. 3 Insertion of the daughter magnet. a The guidewire passed through the side hole of the daughter magnet. b The daughter magnet was pushed towards the proximal end of the atresia by endoscope. c The status of the daughter magnet observed by X-ray. d The daughter magnet was pushed as proximal to the atresia as possible.

Fig. 4 Placement of the parent magnets. a The daughter magnet reached the proximal end of the atresia on its own. b The parent magnets were inserted through anus. c, d Anteroposterior and lateral view after the parent magnets and daughter magnet attracted together.

The surgical procedure of magnetic compression anastomosis.Video 1

After 14 days, the magnets were removed via the anus. A three-month follow-up revealed that the anastomotic site was patent ([Fig. 5]).

Fig. 5 Establishment of the anastomosis. a The magnets were removed 14 days after surgery. b The compressed necrotic tissue between the daughter magnet and parent magnets can be seen after separating them. c Three months later, a colonoscopy showed that the anastomosis was still unobstructed.

Magnetic compression anastomosis has previously been used for the recanalization of colorectal and esophageal obstructions [1] [2] [3] [4]. The successful recanalization of atresia in this case highlights the benefits of combining magnetic compression anastomosis with endoscopy for the treatment of a gastrointestinal obstruction.

Endoscopy_UCTN_Code_TTT_1AQ_2AF

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Lu G, Li J, Ren M. et al. Endoscopy-assisted magnetic compression anastomosis for rectal anastomotic atresia. Endoscopy 2021; 53: E437-E439
• 2 Zhang M, He S, Sha H. et al. A novel self-shaping magnetic compression anastomosis ring for treatment of colonic stenosis. Endoscopy 2023; 55: E1132-E1134
• 3 Zhang M, Sha H, Lu G. et al. Treatment of refractory esophageal stenosis after endoscopic submucosal dissection with magnetic compression anastomosis. Endoscopy 2024; 56: E280-E282
• 4 Krishnan N, Pakkasjärvi N, Kainth D. et al. Role of magnetic compression anastomosis in long-gap esophageal atresia: a systematic review. J Laparoendosc Adv Surg Tech A 2023; 33: 1223-1230

Publication History

Article published online:
25 October 2024