New Technique For Magnetic Compression Anastomosis.8

New Technique for Magnetic Compression
Anastomosis Without Incision for

Gastrointestinal Obstruction
Downloaded from http://journals.lww.com/journalacs by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCy
Teppei Kamada, MD, Hironori Ohdaira, MD, PhD, Hideyuki Takeuchi, MD, Junji Takahashi, MD,
wCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 05/11/2023
Eisaku Ito, MD, Norihiko Suzuki, MD, Satoshi Narihiro, MD, Masashi Yoshida, MD, FACS, PhD,
Eigoro Yamanouchi, MD, PhD, Yutaka Suzuki, MD, PhD
BACKGROUND: Magnetic compression anastomosis (MCA) is a novel technique of anastomosis similar to that
with surgery, but in a minimally invasive manner. Few reports are available on the utility and
feasibility of MCA for gastrointestinal anastomosis without requiring general anesthesia in
humans, owing to the difficulty of delivering magnets. We evaluated the safety, efficacy,
and feasibility of MCA in gastrointestinal obstruction without requiring general anesthesia.
STUDY DESIGN: In this retrospective single-center study, patients who underwent MCA from January 2013 to
October 2019 were included. Adult patients with gastrointestinal obstruction or stenosis,
irrespective of the underlying disease, with severe comorbidities, complicated abdominal
surgical history, or postoperative complications, and who were unable to tolerate surgery,
were eligible for inclusion. Two magnets were delivered by a combination of endoscopic and
fluoroscopic procedures and placed in the lumen of the organ to be anastomosed. The main
outcome was the technical success of MCA.
RESULTS: Fourteen patients underwent MCA, and the technical success of MCA was achieved in 100%
of the cases. The mean procedural time, duration for anastomosis formation, and postoper-
ative hospital stay were 44 minutes, 13 days, and 36 days, respectively. Two patients under-
went anastomotic restenosis, and 1 patient had an anastomotic perforation due to balloon
dilatation to prevent restenosis. The mean follow-up period was 34 months.
CONCLUSIONS: MCA without general anesthesia for gastrointestinal anastomosis is safe, useful, and feasible.
MCA can be a valuable alternative to surgery in gastrointestinal obstruction. (J Am Coll Surg
2021;232:170e177. 2020 The Author(s). Published by Elsevier Inc. on behalf of the
American College of Surgeons. This is an open access article under the CC BY-NC-ND license
[http://creativecommons.org/licenses/by-nc-nd/4.0/].)
In magnetic compression anastomosis (MCA), 2 rare- application, the procedure is expected to be an alternative
earth magnets are placed in the lumen of the organ to to surgery in patients with serious comorbidities, compli-
be anastomosed, inducing necrosis at the compression cated abdominal surgical history, or postoperative
site by allowing them to adsorb. This technique can spon- complications.
taneously induce anastomosis similar to that created by In the esophageal region, esophageal atresia in children
surgery, but with low invasiveness.1 In terms of its clinical has been successfully treated with MCA.2,3 In the hepato-
biliary region, an MCA is successfully performed for
severe biliary stenosis and complete biliary obstruction
Disclosure Information: Nothing to disclose.
that are difficult to manage using conventional nonsur-
Received September 24, 2020; Revised October 7, 2020; Accepted October gical interventions.4-6 However, its application in the
8, 2020.
gastrointestinal region is still being developed. Successful
From the Departments of Surgery (Kamada, Ohdaira, Takeuchi, Takaha-
shi, Ito, N Suzuki, Narihiro, Yoshida,Y Suzuki) and Radiology (Yamanou- gastrointestinal anastomoses in animals using MCA have
chi), International University of Health and Welfare Hospital, Iguchi, been shown, and its noninferiority to conventional anas-
Nasushiobara City, Tochigi, Japan. tomosis with suture or stapling has been reported based
Correspondence address: Teppei Kamada, MD, Department of Surgery, In-
ternational University of Health and Welfare Hospital, 537-3, Iguchi,
on detailed anastomotic pressure tolerance and histologic
Nasushiobara City, Tochigi, 329-2763, Japan. email: teppei0911show@ examinations.7-13 However, there have only been a few re-
yahoo.co.jp ports of human gastrointestinal anastomosis,14-18 and case
ª 2020 The Author(s). Published by Elsevier Inc. on behalf of the American https://doi.org/10.1016/j.jamcollsurg.2020.10.012
College of Surgeons. This is an open access article under the CC BY-NC-ND 170 ISSN 1072-7515/20
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Vol. 232, No. 2, February 2021 Kamada et al New Magnetic Compression Anastomosis Method 171
sites and to calculate the length of the stenosis and the

Abbreviations and Acronyms distance between the magnets.
ASA ¼ American Society of Anesthesiologists
e-CT ¼ enhanced computed tomography
LBC ¼ lithotripsy basket catheter
Magnets used
MCA ¼ magnetic compression anastomosis Samarium cobalt magnets were used. The magnets placed
TPN ¼ total parenteral nutrition at the oral and anal sides of the intestinal tract were referred
to as “daughter” and “parent magnets,” respectively. These
magnets were 10 to 25 mm in diameter and 5 mm thick.

series with large sample sizes are not available. Therefore, They were disc-shaped magnets at 1,800 to 3,500 gauss.
the validity and feasibility of MCA for gastrointestinal The magnets were chosen depending on the diameters of
anastomosis are not clear. the intestine and stenosis (Fig. 1A). We always use magnets
Graves and colleagues14 reported that an effective anas- less than 17.5 mm in size for the small intestine and larger
tomosis could be created using MCA during open surgery than 22.5 mm for the colon.
under general anesthesia, comparable to conventional
intestinal anastomosis with stapling and suturing. We hy- Surgical technique
pothesized that MCA can be a less invasive and valuable With the patient in the supine position, the procedure was
alternative to surgery if it can be performed safely without performed under constant fluoroscopic guidance, with
using general anesthesia. 0.4 mg of flunitrazepam administered intravenously by
This retrospective study aimed to evaluate the safety, a team of 2 surgeons and 1 radiologist. To deliver the
efficacy, and feasibility of MCA for gastrointestinal parent magnet, the stenosis, if present, was temporarily
obstruction without requiring general anesthesia. dilated with a wire-guided balloon catheter (CRE Balloon
Catheter, Boston Scientific), and an endoscope or ileus
METHODS tube was allowed to pass. Then, a 0.045- to 0.049-inch
In this retrospective case series, 14 patients who had un- guidewire (Pathwinder, Create Medic Co, Ltd) was
dergone gastrointestinal anastomosis or gastrointestinal inserted, through which the magnet was delivered
bypass with MCA at the Department of Surgery of the In- (Fig. 1B). A lithotripsy basket catheter (LBC) (Lithotripsy
ternational University of Health and Welfare Hospital, Basket Catheter; Zeon Medical), usually used for biliary
from January 2013 to October 2019, were enrolled. lithotripsy, was used to deliver the magnets to the target
Eligible for inclusion were adult patients with gastrointes- organs. An LBC was used directly through the guidewire
tinal obstruction or stenosis requiring any small or large or under endoscopic guidance. For the distal intestinal
bowel anastomosis to restore bowel continuity, with se- tract, which could not be reached by the LBC, a powerful
vere comorbidities, complicated abdominal surgical his- external magnet was used to deliver the magnet. If the in-
tory, or postoperative complications, and who were testinal tract was completely obstructed, an ileus tube or
unable to tolerate surgery. Patients in whom the adequate endoscope was inserted from the anus or an existing
delivery of magnets was considered impossible and those gastrostomy or enterostomy. Subsequently, the accessible
with interposed organs identified from the pretreatment intestinal tract closer to the oral side was approached and
evaluation were excluded because they were at a high replaced with the guidewire, onto which the magnet was
risk of injury to other organs. delivered using the LBC. The guidewire was bent to
The MCA procedures were approved by the Institu- approximately 30 degrees, 10 cm from the tip, so that
tional Review Board of the International University of the magnet would not be dislodged spontaneously by
Health and Welfare Hospital (Approval No. 13-B-90). peristalsis, which could occur if the magnet moved to
Informed consent was obtained from all patients. The pri- the tip of the guidewire. After confirming that the mag-
mary endpoint was the technical success of MCA. Sec- nets had been adsorbed at the target position, the endo-
ondary endpoints were the procedural time, duration to scope and catheter were removed and the procedure was
anastomosis formation, complications, length of hospital completed.
stay, and the number of days until the start of oral intake.
Postoperative management
Pretreatment evaluation The position of the magnet was checked daily with plain
Patients underwent gastrointestinal series and enhanced abdominal radiography. Completion of the anastomoses
computed tomography (e-CT) to confirm the absence was identified by the change in the position of the mag-
of interposition of other organs between the anastomotic nets. The magnets were spontaneously passed through
172 Kamada et al New Magnetic Compression Anastomosis Method J Am Coll Surg
Figure 1. Magnets and devices used in magnetic compression anastomosis. (A) Samarium cobalt magnet. From
left: 12.5 mm, 15 mm, 17.5 mm, 22.5 mm 5 mm. (B) The magnet is transported by a lithotripsy basket catheter
(arrow).
the anus; if excretion of the magnets was slow, the mag- perforation occurred after the eighth balloon dilation,
nets were retrieved endoscopically. and emergent surgery (open drainage and ileostomy crea-
After the magnets were retrieved, the anastomosis was tion) was performed. Intraoperative findings revealed the
observed using endoscopy within a few days. If restenosis presence of an anastomotic perforation. The postoperative
was expected and the prevention of restenosis was consid- course was uneventful, and the patient was discharged
ered necessary, the ileus tubes were placed to keep the after 120 days of MCA.
anastomosis patent, or balloon dilation was performed
regularly. The required number of balloon dilations Colorectostomy (Case 5) (eFig. 2)
depended on the diameter of the anastomosis. The patient was a 59-year-old man. Open drainage and
transverse loop colostomy were performed for sigmoid
Follow-up diverticular perforation and peritonitis. Sigmoidectomy
(colostomy preserved) was performed 6 months after the
If no symptoms were present after the balloon dilations
surgery, and the patient was referred for complete stenosis
were completed, regular examinations other than those
of the sigmoid colon anastomosis (Fig. 3A). A 17.5-mm
for the underlying disease were not required.
daughter magnet was placed in the sigmoid colon from
the transverse colostomy using an ileus tube. A parent
Case presentation magnet of the same size was placed in the rectum using
Jejunocolostomy (Case 1) (eFig. 1) an endoscope through the anus, and both magnets were
The patient had cervical cancer with recurrence in the adsorbed (Figs. 3B and 3C). An anastomosis was induced
para-aortic lymph nodes and multiple lung metastases (af- 7 days later. Given that the anastomosis was sufficiently
ter radical hysterectomy and bilateral adnexectomy with large, dilatation was not necessary; therefore, the treat-
bilateral pelvic lymphadenectomy). A refractory ileus at ment was completed (Fig. 3D). Two months later, a
the terminal ileum was caused by a disseminated nodule. stoma reversal was successfully performed.
Because surgery was not indicated owing to the severe per-
formance status, intestinal bypass using MCA was Jejunojejunostomy (Case 10) (eFig. 3)
preferred (Fig. 2A). The preoperatively inserted ileus The patient was a 64-year-old man. An open total gastrec-
tube was replaced with a guidewire, and the LBC was tomy was performed for gastric cancer. Repeated endo-
used to deliver a 17.5-mm daughter magnet to the scopic balloon dilatations were performed for the
jejunum 150 cm from the Treitz ligament. A 22.5-mm nonanastomotic stenosis of the proximal jejunum, but
parent magnet was delivered to the transverse colon using they were not effective (Fig. 4A). Intrathoracic anasto-
a colonoscope, and adsorption of both magnets was mosis, which was highly invasive, was considered in a
confirmed (Figs. 2B and 2C). An ileus tube was placed reoperation. The parent magnet could not be passed
in the jejunum to decompress the jejunum, and the pro- through the stenosis; therefore, a balloon catheter was
cedure was completed. An anastomosis was created 11 used to dilate at a pressure of 4 atm to 16 mm for 3 mi-
days later (Fig. 2D). Balloon dilation was performed at nutes. A 17.5-mm parent magnet was delivered to the
7-day intervals to prevent restenosis. An anastomotic anal side of the stenosis using an LBC. Subsequently, a
Figure 2. Patient 1: Large intestinal anastomosis via the small intestine. (A) Stenosis (arrow) due to the disseminated nodules in the terminal
ileum before magnetic compression anastomosis (MCA). (B) Endoscopy and lithotripsy basket catheter (LBC) were combined to transport the
magnet from the oral side to the jejunum. Combined use of endoscopy and LBC to transfer the parent magnet from the anal side to the
transverse colon. (C) Both magnets were adsorbed. (D) Endoscopic view of the completed anastomosis (arrow) (20 days after MCA).
17.5-mm daughter magnet was placed at the end of the gastroenterostomy in 1, and esophagogastrostomy in 1.
proximal jejunum, and both magnets were adsorbed Ten patients had side-to-side anastomosis; 4 had end-to-
(Figs. 4B and 4C). An anastomosis was developed 21 end anastomosis. The magnet diameters (daughter/parent)
days later, which was confirmed by upper endoscopy were 17.5/17.5 mm in 11 patients, 17.5/22.5 mm in 2 pa-
(Fig. 4D). Endoscopic balloon dilation was performed 3 tients, and 15/15 mm in 1 patient.
times to prevent restenosis. The treatment was completed
without a relapse of the symptoms. Surgical outcomes (Table 1)
Technical success with MCA was achieved in all 14
(100%) cases. Each procedure lasted an average of 44 mi-
RESULTS nutes (range 10 to 143 minutes), which was measured
Patients’ characteristics from the time of endoscopic insertion to the time of endo-
Fourteen patients underwent MCA; 9 were men and 5 were scopic removal. The duration of anastomosis creation aver-
women. Average age was 65 years (range 39 to 82 years). aged 13 days (range 5 to 24 days). The time until initiation
Three, 6, and 5 patients had American Society of Anesthe- of oral intake averaged 13 days (range 1 to 34 days) starting
siologists (ASA) physical status classification scores of 2, 3, from the day after the MCA procedure if patients had an
and 4, respectively. The patients’ primary diseases are shown ostomy, and starting the day after anastomosis creation if
in Table 1. The stenosis that was responsible for MCA indi- otherwise, using total parenteral nutrition (TPN) as sup-
cations was located in the small intestine in 9 patients, the plemental nutrition. The mean postoperative hospital
large intestine in 3, the duodenum in 1, and the esophagus stay was 36 days (range 14 to 120 days).
in 1. Eleven (73%) and 3 (27%) stenoses were benign and Anastomotic restenosis, an MCA-related complication,
malignant. The anastomoses were enteroenterostomies in occurred in 2 patients (14%), and anastomotic perfora-
6 patients, colorectostomies in 3, enterocolostomies in 3, tion due to balloon dilatation to prevent restenosis
Figure 3. Patient 5: Large intestinal anastomosis via the large intestine. (A) Complete stenosis of the sigmoid colon anastomosis (arrow). (B)
The magnet was transported from the transverse colon stoma by an ileus tube. A parent magnet was transported from the anus to the
intended site with a lower gastrointestinal endoscope. (C) Both magnets were adsorbed. (D) Endoscopic view of the completed anastomosis
(14 days after magnetic compression anastomosis).
Figure 4. Patient 10: Small intestinal anastomosis via the small intestine. (A) A non-anastomotic stenosis of the elevated jejunum (arrow).
(B) Before balloon dilatation of the stenotic segment, the parent magnet was transported from the oral to the anal side of the stenosis by a
lithotripsy basket catheter (LBC). Endoscopy and LBC were combined to transport the daughter magnet to the oral side of the stenosis. (C)
Both magnets were adsorbed. (D) Endoscopic view of the completed anastomosis (arrow) (25 days after magnetic compression
anastomosis).
occurred in 1 (7%). Balloon dilatation for restenosis and had favorable results, with technical success in 13 pa-
prevention was performed in 8 patients (57%; there was tients (89%) and minor complications (stent deviation,
an overlap with the treatment dilation). Four patients obstruction) in 4 (31%). Van Hooft and coworkers16
(29%) died from worsening of their underlying disease. performed a similar procedure in 18 patients with malig-
The average follow-up period was 34 months (range nant gastric obstruction and reported technical success in
6 to 57 months). 12 patients (67%); 1 patient experienced a serious
complication (stent perforation) and 3 patients had minor
complications (stent migration). However, the study was
DISCUSSION terminated prematurely. The authors reported that
Our study revealed that the use of MCA without the need gastrointestinal anastomosis by MCA was feasible, but
for general anesthesia to create a gastrointestinal anasto- metallic stent insertion could not be recommended.16
mosis is safe and feasible. The greatest benefit of MCA These last 2 studies were limited to gastrojejunal bypass
is that it allows the creation of a gastrointestinal anasto- for malignant stenosis of the upper gastrointestinal tract
mosis similar to surgery, with minimal invasiveness and and required insertion of a metallic stent.
without requiring general anesthesia. Therefore, at our One of the reasons for the unpopularity of MCA as the
institution, MCA is indicated for patients in whom a method of creating gastrointestinal anastomosis is the dif-
gastrointestinal bypass was required, irrespective of the ficulty in placing magnets in the distal intestine.9 To
primary underlying disease. The procedure is an alterna- resolve this problem, we delivered magnets by using a
tive to the initial treatment in patients with severe compli- combination of LBC, ileus tube, and endoscopes, and
cations who cannot tolerate surgery, or reoperation in achieved a technical success rate of 100% in all the gastro-
patients with complicated abdominal surgical history or intestinal regions. The magnets were delivered smoothly
postoperative complications. using the guidewire and LBC under fluoroscopic guid-
With respect to the gastrointestinal region, although re- ance in patients in whom the delivery could not be
ports of successful MCA in animal studies have been performed endoscopically.
known,7-13 few reports are available on the utility and In patients with an ostomy, the use of the ostomy as an
feasibility of MCA for gastrointestinal anastomosis in entry point allowed easier placement of magnets. In a pre-
humans. Graves and colleagues14 reported that intestinal vious study,14 a hole was made at the center of the
anastomosis in 5 patients, similar to that obtained from adsorbed magnet during laparotomy, and immediate
surgery, could be safely created using MCA; however, decompression was obtained. It was difficult to create a
their study was limited by a small sample size, and the decompression hole during endoscopic and fluoroscopic
magnets were placed during open surgery. The authors procedures, and if decompression was required, a decom-
concluded that the placement of magnets under laparo- pression tube was placed at the oral side of the adsorbed
scopic, endoscopic, or fluoroscopic procedures would be magnet in this study.
desirable. Chopita and associates15 performed a gastrojeju- Magnets are usually retrieved after defecation or endo-
nal bypass using MCA with an endoscopically inserted scopic retrieval in the absence of prolonged excretion.
metallic stent in 15 patients with malignant obstruction When a bypass for the ileus is performed, it is difficult
Vol. 232, No. 2, February 2021

Table 1. Patient Characteristics and Procedures
Patient no.
Characteristic 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Sex F M M F M M F M M M M M F F
Age, y 49 46 64 39 59 70 81 76 82 64 71 73 68 71
Primary disease Cervical Ca A Ca Rectal Ca D Ulcer S Dive Rectal Ca S Dive E Ca D GIST Gastric Ca Gastric Ca Gastric Ca AIH G Ca
ASA score 4 4 4 2 2 3 2 4 4 3 3 3 3 3
Stenosis type Ileum Ileum Jejunum Duodenum Sigmoid Rectal Sigmoid Esophagus Jejunum Jejunum Jejunum Jejunum Ileum Jejunum
Malignancy Malignant Malignant Malignant Benign Benign Benign Benign Benign Benign Benign Benign Benign Benign None
Kamada et al
Ostomy None Ileostomy Colostomy None Colostomy Colostomy Colostomy Jejunostomy None Jejunostomy None None Enterocutaneous None
fistula
Anastomosis J-T I-T J-A G-J S-R S-R S-S E-G J-J J-J J-J J-J I-I J-J
Size, mm 17.5 17.5 17.5 15 17.5 17.5 17.5 17.5 17.5 17.5 17.5 17.5 17.5 17.5
EEA/SSA SSA SSA SSA SSA EEA EEA EEA SSA SSA SSA SSA SSA SSA EEA
Size, mm 22.5 22.5 22.5 15 17.5 17.5 17.5 17.5 17.5 17.5 17.5 17.5 17.5 17.5
Time, mins 95 47 13 80 32 30 23 143 25 43 10 36 27 16
New Magnetic Compression Anastomosis Method

MCA duration, d 11 7 10 23 7 13 5 24 14 21 12 17 8 13
Complication Perforation None None Restenosis None None None None None None None None None Restenosis
due to
dilation
Dilation, n þ(8) e þ(3) þ(47) e e e e þ(1) þ(3) þ(9) þ(8) e þ(30)
Hospital stay, d 120 30 33 42 17 14 17 40 33 33 34 26 48 22
Prognosis Death Death Death e e e e e Death e e e e e
Days to oral intake 12 None 12 25 1 1 1 28 1 34 15 18 1 14
Follow-up, mo 6 1 12 53 46 36 7 13 1 38 45 57 6 20
A, ascending colon; AIH, abdominal incision hernia; ASA, American Society of Anesthesiologists physical status classification; Ca, cancer; D, descending colon; D Ulcer, duodenal ulcer; E, esophagus;
EEA, end-to-end anastomosis; G, stomach; GIST, duodenal gastrointestinal stromal tumor; I, ileum; J, jejunum; MCA, magnetic compression anastomosis; S, sigmoid colon; SD, sigmoid diverticulitis;
SSA, side-to-side anastomosis; T, transverse colon.
175
to retrieve the magnets if they are dropped in the blind months after complete anastomosis, and balloon dilation
loop tract. To prevent this, a heavier magnet is placed at a high pressure was performed after complete epitheli-
at the anal side of the anastomosis and the adsorbed mag- alization was achieved.
nets are dropped to the anal side (patients 1 to 3). Other complications, such as anastomotic leakage,
Complete anastomosis was achieved between 8 and 24 injury to other organs, and perforation due to long-term
days for the different target organs (Table 1). The dura- magnet placement, were not observed. For MCA, accu-
tion of anastomosis according to the size of the magnets rate anatomic understanding of the presence of interposed
was not different. Previous reports have noted the retrieval objects between organs using preoperative 3D-CT is
of magnets after 2 to 8 weeks14 for small intestinal anasto- particularly important to avoid injury to other organs.
mosis and 7 to 10 days15 for gastrojejunal anastomoses, In some patients, the magnet may adsorb to the mesen-
with no major differences from our results. Eleven pa- teric side, which is expected to interfere with intestinal
tients (79%) with an ASA score of 3 or higher had favor- blood flow. However, complications have not been
able results in our study. MCA was performed as the observed. Given that the marginal blood flow is abundant,
initial treatment in 3 patients (21%) with malignant ste- we think that the interposition of small vessels between
nosis and an ASA score of 4, and oral intake became the magnets is not problematic. MCA can be performed
possible after successful MCA. Considering the low per- safely even in patients with a 5-cm distance between the
formance status caused by the progression of the underly- target organs determined from preoperative CT. The dis-
ing disease and massive ascites, minimally invasive MCA tance could be shortened by endoscopic or fluoroscopic
can be an alternative to conventional palliative gastroin- procedures and intestinal peristalsis during the procedure.
testinal bypass surgery. Another advantage over surgery On the basis of this experience, we think that the specific
is that chemotherapy can be started almost immediately limitation of the distance is approximately 5 cm.
after the procedure, without a waiting period. As a limitation of this study, the MCA should be per-
Complications encountered were restenosis in 2 pa- formed by well-trained teams because specific techniques
tients (14%) and anastomotic perforation in 1 patient for delivering magnets are required. The widespread use
(7%) due to balloon dilation to prevent restenosis. In 2 of MCA requires development of a dedicated device,
cases of restenosis, anastomotic balloon dilatation was which will require simplification and standardization of
performed regularly, and the stenosis improved; however, the procedure. Moreover, in the absence of a supple-
1 patient experienced anastomotic perforation with gener- mental nutritional pathway, it is a challenge to force
alized peritonitis immediately after the eighth balloon parenteral nutrition until the anastomosis is completed.
dilatation, and an emergency operation was required. Moreover, MRI is contraindicated because a magnet is
Pichakron and colleagues7 performed a histopathologic present in the body. Given that this was a single-center
analysis in gastrojejunostomy with MCA in experimental retrospective study with a small sample size, future studies
animals and presented a mechanism for MCA. The necro- involving a larger number of patients are required.
sis of the intercalated material was evoked during the first
week, anastomosis became patent by the second week, and
fibrosis around the anastomosis became prominent. By CONCLUSIONS
week 6, re-epithelialization had occurred across the MCA without general anesthesia can be a valuable alter-
fibrosis and inflammation. In our experience, the resteno- native to surgery for gastrointestinal obstruction.
sis in patients who underwent MCA was caused by exces-
sive fibrosis and scarring of the anastomotic site, which Author Contributions
may not be completely covered by the mucosa after the Study conception and design: Kamada
removal of the magnet. In Patient 1, the perforation Acquisition of data: Kamada, Takeuchi, Takahashi, Ito,
was thought to be caused by excessive balloon dilatation N Suzuki, Narihiro, Yoshida
before complete epithelialization had been achieved at 8 Analysis and interpretation of data: Kamada
weeks after complete anastomosis. Drafting of manuscript: Kamada
Given anastomotic perforation due to balloon dilation, Critical revision: Ohdaira, Yamanouchi, Y Suzuki
we provided a preventive measure for restenosis. If the
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177.e1 Kamada et al New Magnetic Compression Anastomosis Method J Am Coll Surg
eFigure 1. The schema of Patient 1 (jejunocolostomy by magnetic compression anastomosis).
eFigure 2. The schema of Patient 5 (colorectostomy by magnetic compression anastomosis).

Vol. 232, No. 2, February 2021 Kamada et al New Magnetic Compression Anastomosis Method 177.e2
eFigure 3. The schema of Patient 10 (jejunojejunostomy by magnetic compression

anastomosis).

New Technique For Magnetic Compression Anastomosis.8

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New Technique for Magnetic Compression

Anastomosis Without Incision for

sites and to calculate the length of the stenosis and the

magnets were 10 to 25 mm in diameter and 5 mm thick.

Vol. 232, No. 2, February 2021

New Magnetic Compression Anastomosis Method

eFigure 1. The schema of Patient 1 (jejunocolostomy by magnetic compression anastomosis).

eFigure 2. The schema of Patient 5 (colorectostomy by magnetic compression anastomosis).

eFigure 3. The schema of Patient 10 (jejunojejunostomy by magnetic compression

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