O2163: Magnetic Esophageal Anastomosis: A study by the Canadian Consortium for Research in Pediatric Surgery

Background: Magnetic anastomosis is an innovative technique for establishing esophageal continuity in infants born with esophageal atresia. Few case series featuring this technology have been published, with even fewer reports on complications. We present the entire Canadian experience with this approach.

Methods: A retrospective review of all esophageal atresia patients treated with magnetic anastomosis in Canada was conducted through the Canadian Consortium for Research in Pediatric Surgery (CanCORPS). Case information was pooled and analyzed.

Results: Magnetic anastomoses were attempted in 9 patients treated at 4 Canadian centres, including 4 Type A, 2 Type B, and 3 Type C. The median pre-operative esophageal gap was 3.0 cm (range 0.0–5.5 cm). In six patients, magnetic anastomosis was used as a salvage technique, after failed attempted primary repair. Seven patients (78%) achieved esophageal patency at a median of 10 days (range 4-13) after magnet insertion. Strictures developed in all successful cases and required a median of 10 dilatations (range 3-16). In one patient with failed anastomosis, the proximal magnet perforated the proximal esophageal pouch, while in the second case, the magnets failed to couple together. One patient had an anastomosis form that required operative intervention shortly afterwards to both revise the anastomosis and address a missed fistula. See Table 1. Median length of follow-up was four years.

Conclusion: In this national Canadian experience, magnetic anastomosis was successful in establishing esophageal continuity in the majority of patients. However, all patients in this series developed strictures requiring multiple dilatations, and there was a substantial risk of complications requiring additional operative procedures. Further refinement of this technology and technique may establish magnetic anastomosis as another tool in the pediatric surgeon’s armamentarium for treating long-gap and other challenging cases of esophageal atresia.