Procedure
patent anastomotic diversion, metal bowel
SLOUGHING
Under general anesthesia, a marker was laparoscopically placed in the ileal mesentery 250 cm from the cecum with medium to large titanium clips, and a retrievable metal bowel clamp (Aesculap AG, Tuttlingen, Germany) was placed 10–15 cm distal to the ligament of Treitz. The first (distal) MS magnet was transported orogastrically by flexible endoscopy (Pediatric 190 colonoscope, Olympus America, Center Valley, PA) to the fourth part of the duodenum and released in the proximal jejunum, where it was attracted toward the clamp. The endoscope was retracted to the level of the stomach and its contents aspirated. A positioning device was used to grasp the magnet, the clamp was removed, and the positioner directed the magnet through the jejunal lumen to the marked ileal position. The distal magnet in the ileum was elevated over the transverse colon with 2 non-magnetic bowel forceps and brought anterior and latero-lateral to the duodenum. The second (proximal) magnet was delivered through the endoscope to the intended magnet fusion site in the first duodenum and released to self-align with the distal magnet through the intestinal walls. The endoscope and magnet positioning device were withdrawn, and the mesenteric defect was closed with running 2–0 silk suture, on its left side (Fig. Side-to-side duodeno-ileal magnetic compression anastomosis procedure with the magnet system (MS). Postoperatively, in 2–4 weeks, the magnets were expected to be fully fused after compressing, necrosing, and sloughing the tissue between them. Subsequently, paired magnets were intended to detach from the duodeno-ileal site and be expelled naturally. Food flows through the duodenal lumen and also through the patent anastomotic diversion into the ileal lumen.