Magnamosis for long gap esophageal atresia: Minimally invasive “fatal attraction”

• Published in: Journal of pediatric surgery Vol. 58; no. 3; pp. 405 - 411
• Main Authors: Conforti, Andrea, Pellegrino, Chiara, Valfré, Laura, Iacusso, Chiara, Schingo, Paolo Maria Salvatore, Capolupo, Irma, Sgro’, Stefania, Rasmussen, Lars, Bagolan, Pietro
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023
• Subjects: Anastomosis, Surgical - methods; Digestive System Surgical Procedures - adverse effects; Esophageal atresia; Esophageal Atresia - complications; Esophageal Atresia - surgery; Esophageal Stenosis - etiology; Humans; Infant; Long gap esophageal atresia; Magnamosis; Magnetic anastomosis; Magnetics; Minimal invasive surgery; Treatment Outcome; Magnamosis; DAP; LGEA; Pt; vbs; Esophageal atresia; Minimal invasive surgery; fps; Long gap esophageal atresia; EA; Magnetic anastomosis
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2022.08.018

•Magnamosis represents a minimally invasive treatment for LGEA with limited knowledge available.•A prospective evaluation of 5 LGEA patients consecutively treated with magnetic anastomosis is here reported.•Also highlighting 6-months postoperative outcomes. Aim of study is to report our preliminary experience with magnetic anastomosis (magnamosis) treating long-gap esophageal atresia (LGEA), the most challenging condition of esophageal atresia continuum. Magnamosis has been reported in 20 patients worldwide as an innovative and marginally invasive option. Prospective evaluation of all LGEA patients treated with magnamosis was performed (study registration number: 2535/2021). Main outcomes considered were demographic and surgical features, postoperative complications and feeding within 6-month of follow-up. Between June 2020 and January 2021, 5 LGEA patients (Type A, Gross classification) were treated. Median preoperative gap was 5 vertebral bodies. Magnetic bullets were placed at an average age of 81 days of life, leading to successful magnamosis in all cases: 4 infants had primary magnetic repair (one after thoracoscopic mobilization of the pouches), 1 patient had a delayed magnamosis after Foker's procedure. Esophageal anastomosis was achieved after an average of 8 days. No anastomotic leak was found. All patients developed anastomotic stenosis at 6-month follow-up, requiring a mean of 6 dilations each. Full oral feeding was achieved in 3 patients, while 2 were still on oral-gastrostomy feeding. One patient experienced small esophageal perforation after dilation (3 months after magnamosis), distal to the anastomotic stricture and subsequently developed oral aversion. Our preliminary results suggest magnamosis a safe and effective minimally invasive option in patients with LGEA. Absence of postoperative esophageal leaks may represent a major advantage of magnamosis over conventional surgery, although possible high rate of esophageal stenosis should be further evaluated. IV (Case series with no comparison group)