Highlights
- •What is currently known about this topic? There are no detailed reports of significant complications following magnamosis for esophageal atresia beyond anastomotic strictures.
- •What new information is contained in this article? We propose the following inclusion criteria and considerations for magnamosis: an esophageal gap truly less than four centimeters off tension with standardized measurement, cautious use with a history of prior esophageal surgery, no associated tracheobronchomalacia or great vessel anomaly that would benefit from concurrent repair, and ideally to be used in centers equipped to manage potential complications.
Abstract
Background
The use of magnets for the treatment of long gap esophageal atresia or “magnamosis”
is associated with increased incidence of anastomotic strictures; however, little
has been reported on other complications that may provide insight into refining selection
criteria for appropriate use.
Methods
A single institution, retrospective review identified three cases referred for treatment
after attempted magnamosis with significant complications. Their presentation, imaging,
management, and outcomes were reviewed.
Results
All three patients had prior cervical or thoracic surgery to close a tracheoesophageal
fistula prior to magnamosis, creating scar tissue that can prevent magnet induced
esophageal movement, leading to either magnets not attracting enough or erosion into
surrounding structures. Two patients had a reported four centimeter esophageal gap
prior to attempted magnamosis, both failing to achieve esophageal anastomosis, suggesting
that these gaps were either measured on tension with variability in gap measurement
technique, or that the esophageal segments were fixed in position from scar tissue
and unable to elongate. One patient had severe tracheobronchomalacia requiring tracheostomy,
with improvement in his airway after eventual tracheobronchopexies, highlighting that
magnamosis does not address comorbidities often associated with this patient population.
Conclusions
We propose the following inclusion criteria and considerations for magnamosis: an
esophageal gap truly less than four centimeters off tension with standardized measurement
across centers, cautious use with a history of prior thoracic or cervical esophageal
surgery, no associated tracheobronchomalacia or great vessel anomaly that would benefit
from concurrent repair, and ideally to be used in centers equipped to manage potential
complications.
Level of evidence
Level IV treatment study.
Keywords
Abbreviations:
LGEA (long gap esophageal atresia), EA (esophageal atresia), TEF (tracheoesophageal fistula), TBM (tracheobronchomalacia), ALTE (apparent life-threatening event), GVA (great vessel anomaly)To read this article in full you will need to make a payment
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References
- Electromagnetic bougienage to lengthen esophageal segments in congenital esophageal atresia.N Engl J Med. 1975; 293 (Aug 28): 429-432
- Use of magnets as a minimally invasive approach for anastomosis in esophageal atresia: long term outcomes.J Laparoendosc Adv Surg Tech A. 2019; 29 (Oct): 1202-1206
- Magnamosis for esophageal atresia is associated with anastomotic strictures requiring an increased number of dilatations.J Pediatr Surg. 2020; 55 (May): 821-823
- Long gap esophageal atresia.Semin Pediatr Surg. 2017; 26 (Apr): 72-77
- Foker process for the correction of long gap esophageal atresia: primary treatment versus secondary treatment after prior esophageal surgery.J Pediatr Surg. 2015; 50 (Jun): 933-937
- Contemporary outcomes of the Foker process and evolution of treatment algorithms for long gap esophageal atresia.J Pediatr Surg. 2021; 56 (Epub 2021 Feb 26.PMID: 33766420): 2180-2191https://doi.org/10.1016/j.jpedsurg.2021.02.054
Article info
Publication history
Published online: November 13, 2021
Accepted:
November 5,
2021
Received in revised form:
October 24,
2021
Received:
September 22,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
