Esophageal magnetic compression anastomosis in dogs

Abstract

Background: Magnetic compression anastomosis (MCA) is a novel suture-free reconstruction of the digestive tract. It has been used in gastrointestinal anastomosis, jejunal anastomosis, cholangioenteric anastomosis and so on. The traditional operative outcomes of congenital esophageal atresia and benign esophageal stricture are poor, and there are too many complications postoperatively.

Aim: To test MCA technology to reconstruct the esophagus in dogs, prior to studying the feasibility and safety of MCA in humans.

Methods: Thirty-six dogs were randomized into either the study or control group (n = 18 per group). The dogs in the study group were subjected to end-to-end esophageal anastomosis with the magnetic compression device, while those in the control group underwent hand-sewn anastomosis with 4-0 absorbable multifilament Vicryl. We used interrupted single-layer inverting sutures. The anastomosis time, gross appearance, weight and pathology of the anastomosis were evaluated at one month, three months and six months postoperatively.

Results: The anastomosis time of the MCA group was shorter than that of the hand-sewn group (7.5 ± 1.0 min vs 12.5 ± 1.8 min, P < 0.01). In the MCA group, X-ray examination was performed every day to locate the magnetic device in the esophagus before the magnetic device fell off from the esophagus. In the hand-sewn group, dogs did not undergo X-ray examination. One month after the surgeries, the mean weight of the dogs in the hand-sewn group had decreased more than that of the dogs in the MCA group (11.63 ± 0.71 kg vs 12.73 ± 0.80 kg, P < 0.05). At 3 mo and 6 mo after the operation, the dogs' weights were similar between the two groups (13.75 ± 0.84 kg vs 14.03 ± 0.82 kg, 14.93 ± 0.80 kg vs 15.44 ± 0.47 kg). The number of inflammatory cells in MCA group was lower than that in hand-sewn group on 1 mo after operation.

Conclusion: MCA is an effective and safe method for esophageal reconstruction. The anastomosis time of the MCA group was less than that of the hand-sewn group. This study shows that MCA technology may be applied to human esophageal reconstruction, provided these favorable results are confirmed by more publications.

Keywords: Anastomosis; Dog; Esophagus; Hand sewn; Magnetic; Reconstruction.

Figure 1

Surgical procedures of magnetic compress esophagus anastomosis. A: Transecting the esophagus at the diseased region; B: Placing the parent magnetic ring (PMR) and daughter magnetic ring (DMR) on the upper and lower ends of esophagus; C: The PMR and DMR attract each other and create the anastomosis, and the esophagus reconstruction is complete, the dispositive allows food passage; D: The magnetic devices fall off the esophagus into the stomach, and the esophagus lumen is completely open.

Figure 2

The magnetic device and the appearance on X-ray, the esophageal anastomosis of magnetic compression anastomosis and hand-sewn suture. A: The magnetic device, composed of two magnetic rings and one special catheter; B: The magnetic ring position on X-ray postoperatively, and the anastomosis face is smooth; C: Using the magnetic compression anastomosis technology to finish the esophageal anastomosis; D: The anastomosis by hand-sewn suture.

Figure 3

The analysis about anastomosis time, weight changes, the time of the magnetic device fell and the number of inflammatory cells between two groups. A: The anastomosis time of the magnetic compression anastomosis group and hand-sewn group. There were 18 dogs in each group; B: The dogs were weighed at 1 mo, and every group contained 6 dogs. There was a significant difference between the two groups; C: The time when the magnetic device had fallen into the stomach of 18 dogs; D-F: The number of inflammatory cells respectively at 1 mo, 3 mo and 6 mo. MCA: Magnetic compression anastomosis.

Figure 4

Gross appearance of the anastomosis in magnetic compression anastomosis and hand-sewn group. A: The tissue of magnetic compression anastomosis (MCA) group is thin at 1 mo, but the mucous membrane is intact; B: Anastomotic tissue of the MCA group at 3 mo; C: At 6 mo, the tissue becomes smooth and flat in the MCA group. There is little difference from normal tissue; D: The tissue of the hand-sewn anastomotic stoma is incomplete, and the mucous membrane has a small pinhole at 1 mo, which was caused by the suture needle. Red arrow indicates; E: Anastomotic tissue of the hand-sewn group at 3 mo; F: Anastomotic tissue of the hand-sewn group at 6 mo.

Figure 5

Hematoxylin and eosin dye of the anastomotic tissue in magnetic compression anastomosis and hand-sewn group. Each image consists of two parts, one with a 2 × objective view and the other with a 40 × objective view. A: The anastomotic tissue of the magnetic compression anastomosis (MCA) group at 1 mo. The mucous membrane was intact, but the muscularis was separated; B: The anastomotic tissue of the hand-sewn group at 1 mo. There were more inflammatory cells in the tissue of the hand-sewn group than that of the MCA group; C: The anastomotic tissue of the MCA group at 3 mo. The muscularis became continuous; D: The anastomotic tissue of the hand-sewn group at 3 mo; E: The anastomotic tissue of the MCA group at 6 mo; F: The anastomotic tissue of the hand-sewn group at 6 mo.

Figure 6

Masson Thrichrome dye staining of the anastomotic tissue in magnetic compression anastomosis and hand-sewn group. Each image consists of two parts, one with a 2 × objective view and the other with a 40 × objective view. A: The anastomotic tissue of the magnetic compression anastomosis (MCA) group at 1 mo. The mucous membrane was intact, but the muscularis was separated at 1 mo, and the appearance was similar to that of hematoxylin and eosin staining; B: The anastomotic tissue of the hand-sewn group at 1 mo. There were more collagenous fibers than that in MCA group; C: The anastomotic tissue of the MCA group at 3 mo. The muscularis became continuous; D: The anastomotic tissue of the hand-sewn group at 3 mo; E: The anastomotic tissue of the MCA group at 6 mo; F: The anastomotic tissue of the hand-sewn group at 6 mo.