title: Using external magnet guidance and endoscopically placed magnets to create suture-free gastro-enteral anastomoses.
abstract: BACKGROUND
  To facilitate endolumenal and natural orifice procedures, this study evaluated a novel technique using external and endoscopically placed magnets to create suture-free gastroenteral anastomoses.
  
  
  METHODS
  Seven anesthetized adult swine underwent endoscopic placement of magnets into the small bowel and stomach. Using external magnets, the endoscopically placed internal magnets were brought into opposition under endoscopic view. After 1-2 weeks, the pigs were killed and analyzed. At laparotomy and under sterile conditions, peritoneal cultures were obtained. The anastomoses were evaluated endoscopically and tested using an air insufflation test. Finally, the anastomoses were resected and evaluated microscopically.
  
  
  RESULTS
  The average operative time for endoscopic placement of the magnets was 34.3 +/- 14.8 min. Successful placement and creation of anastomoses occurred in six of the pigs. One pig did not form an anastomosis because the magnets were too large to pass through the pylorus at the time of attempted magnet placement. Six swine experienced uncomplicated postoperative courses. One pig's postoperative course involved constipation for several days, requiring additional fluids and fiber supplementation. The findings at endoscopy showed that the magnets were adhered to the anastomosis, which were easily freed, or within the stomach. The air insufflation test results were negative for all the pigs. At laparotomy, there was no evidence of infection, abscess, or leak, but two peritoneal culture results were positive with scant growth of Staphylococcus aureus and coagulase-negative staphylococcus, presumably contaminants. Microscopically, the anastomoses illustrated granulation and fibrous connective tissue without evidence of infection or leak.
  
  
  CONCLUSIONS
  Endoscopically placed magnets with external magnet guidance is a feasible and novel approach to creating patent gastroenteral anastomoses without abdominal incisions or sutures.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA. chrismyers2@hotmail.com
authors.forename: Christopher
authors.initials: C
authors.lastname: Myers
authors.forename: Benjamin
authors.initials: B
authors.lastname: Yellen
authors.forename: John
authors.initials: J
authors.lastname: Evans
authors.forename: Eric
authors.initials: E
authors.lastname: DeMaria
authors.forename: Aurora
authors.initials: A
authors.lastname: Pryor
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D004195:Disease Models, Animal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D007583:Jejunum / Q000601:surgery*; D008280:Magnetics / Q000295:instrumentation*; D009354:Neodymium; D013270:Stomach / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013552:Swine
chemical_list: D009354:Neodymium