Magnetic Compression Anastomosis for Anorectal Malformations: Feasibility and Efficacy in Swine Model and Clinical Observation.

BACKGROUND

Patients with anorectal malformations (ARM) commonly experience post-operative bowel dysfunctions due to inherent neuromuscular dysplasia and surgical damage to extraluminal structures. Magnetic compression anastomosis (MCA) minimizes injury to the perirectal neurovascular bundle and sphincter muscles via an endoluminal approach. We evaluated the preclinical feasibility and healing efficacy of a novel MCA device in a swine model of ARM and applied the device to an ARM patient.

METHODS

Two prototype MCA devices (8 mm and 10 mm diameter) were tested at piglets'abdominal wall tissue to evaluate suitable magnetic force to cause local ischemia and necrosis. Eight piglets underwent ARM modeling and were divided into MCA or hand-sewn (HS) anastomosis groups (n = 4 per group). After two weeks of monitoring, the piglets were sacrificed. Radiography assessed the MCA progression, and anastomosis integrity was evaluated through histology. The device was later modified and applied to an infant with intermediate ARM.

RESULTS

The 10 mm MCA devices successfully aligned at the piglets'abdominal wall tissue, while the 8 mm MCA device failed. The 10 mm MCA devices were selected for rectoanal anastomosis in model and showed an average anal recanalization time of 8 days, with smooth anastomosis sites and no foreign body response. Minimal inflammation was seen in the MCA group compared to HS group. The modified MCA device was applied to the ARM patient, with successful anastomosis by postoperative day 8.

CONCLUSION

MCA is a safe and effective method for anastomosis in ARM, providing a foundation for further clinical applications.

LEVEL OF EVIDENCE: III.