Magnamosis

Magnamosis refers to the concept of performing magnetic compressive anastomosis using two magnets that approach each other due to its attracting forces sloughing the tissue in between them and creating a union. Anastomosis between different parts of our body is a fundamental procedure performed in surgery. Most anastomosis are either hand-sewn or made using mechanical staplers device. Recently a magnamosis device was utilized to perform bowel anastomosis in humans. The magnamosis device is a pair of self-centering rare earth neodymium-iron-boron ring magnets encased in a specially-engineered polycarbonate shell. To create an anastomosis a single magnetic (Harrison ring) is placed within the lumen of each segment of intestine where the union is desired. When the two rings are joined the interposed tissue in between is compressed causing necrosis and anastomosis formation. The device then passes through the newly formed anastomosis and leaves no foreign bodies. The patient then passes the device through the rectum with bowel movement. The magnamosis device has been found to create histologically well-formed anastomosis with burst strength comparable or even better that hand-sen or stapled anastomosis. One side of the device has a slightly convex surface whereas the other side is slightly concave. The compressive forces on the bowel wall causes transmural ischemia and necrosis centrally allowing for remodeling of the bowel in the periphery gradually forming a full-thickness anastomosis. The device is passed in the stools seven to 14 days later depending on the motility of the bowel. Patients can be safely discharge home prior to passing the magnets. The concept of magnamosis has also been utilized for the management of rectal atresia, bilioenteric, esophageal, gastroenteric and vascular anastomosis. It has also been used to managed bile ducts strictures. Magnamosis device is a safe and effective means of sutureless full-thickness bowel anastomosis with serosal apposition.

References:
1- Jamshidi R, Stephenson JT, Clay JG, Pichakron KO, Harrison MR: Magnamosis: magnetic compression anastomosis with comparison to suture and staple techniques. J Pediatr Surg. 44(1):222-8, 2009
2- Pichakron KO, Jelin EB, Hirose S, Curran PF, Jamshidi R, Stephenson JT, Fechter R, Strange M, Harrison MR: Magnamosis II: Magnetic compression anastomosis for minimally invasive gastrojejunostomy and jejunojejunostomy. J Am Coll Surg. 212(1):42-9, 2011
3- Wall J, Diana M, Leroy J, Deruijter V, Gonzales KD, Lindner V, Harrison M, Marescaux J: MAGNAMOSIS IV: magnetic compression anastomosis for minimally invasive colorectal surgery. Endoscopy. 45(8):643-8, 2013
4- Russell KW, Rollins MD, Feola GP, Scaife ER: Magnamosis: a novel technique for the management of rectal atresia. BMJ Case Rep. 2014 Aug 5;2014.
5- Xue F, Guo HC, Li JP, Lu JW, Wang HH, Ma F, Liu YX, Lv Y: Choledochojejunostomy with an innovative magnetic compressive anastomosis: How to determine optimal pressure? World J Gastroenterol. 22(7):2326-35, 2016
6- Dorman RM, Vali K, Harmon CM, Zaritzky M, Bass KD: Repair of esophageal atresia with proximal fistula using endoscopic magnetic compression anastomosis (magnamosis) after staged lengthening. Pediatr Surg Int. 32(5):525-8, 2016
7- Graves CE, Co C, Hsi RS, Kwiat D, Imamura-Ching J, Harrison MR, Stoller ML: Magnetic Compression Anastomosis (Magnamosis): First-In-Human Trial. J Am Coll Surg. 2017 Aug 23. pii: S1072-7515(17)31701-5. doi: 10.1016/j.jamcollsurg.2017.07.1062



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