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Magnetic Anastomosis for Biliojejunostomy: First Prospective Clinical Trial

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Abstract

Background

Magnetic compression anastomosis (magnamosis, MCA) has been verified safe and effective by us and others in animal bilioenteric anastomosis (BEA). The objective of the present study was to introduce clinical application of magnetic compression bilioenteric anastomosis (MC-BEA) with a unique device in series of patients.

Methods

Patients with obstructive jaundice with an indication of BEA were prospectively enrolled from 2012 to 2015. After dissection of bile ducts, the mother ring and drainage tube were placed in the proximal bile duct and the purse-string suture was tightened over the drainage tube. The drainage tube was introduced into the jejunal lumen at the anastomotic site and used to guide the daughter ring to assemble with the mother ring. All the patients were routinely followed up for magnets discharge or any complications associated.

Results

Forty-one patients were included. Thirty-four (82.9%) patients had a malignant primary disease, while seven (17.1%) had benign disease. The median time for MC-BEA was 10.5 min (interquartile range [IQR] 8.3–13.0 min). No perioperative morbidity or mortality associated with MC-BEA was observed. The median time for a patent bilioenteric anastomosis formation was 19.0 days (IQR 14.5–23.0 days), and the magnets were discharged with a median postoperative duration of 35.0 days (IQR 28.0–43.0 days). With a median follow-up of 547.5 days (range 223–1042 days), no patients had biliary fistula, while two (4.9%) developed anastomotic stricture at 4 months and 14 months after surgery, and underwent reoperation for reconstruction of BEA.

Conclusions

MCA is a safe, effective, and time-saving modality for biliojejunostomy.

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Acknowledgements

The authors thank Dr. Zhi-Min Geng, Dr. Xue Yang and other collaborators in Department of Hepatobiliary Surgery for the technical support in surgery; Dr. Rui-Xue Luo in Northwest Institute for Non-ferrous Metal Research, and Dr. Di-Chen Li in the Mechanical Engineering Department of Xi’an Jiaotong University for their support in machining and mechanical property test of the magnets.

Funding

National Natural Science Foundation of China (30830099, 81470896, 81127005).

Author information

Correspondence to Xu-Feng Zhang or Yi Lv.

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All authors declare that they have no disclosures to report.

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Liu, X., Yan, X., Zhang, H. et al. Magnetic Anastomosis for Biliojejunostomy: First Prospective Clinical Trial. World J Surg 42, 4039–4045 (2018) doi:10.1007/s00268-018-4710-y

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