Side-to-side magnet anastomosis system duodeno-ileostomy with sleeve gastrectomy: early multi-center results

• DOI: 10.1007/s00464-023-10134-6
• Publication Date: 2023-05-22T17:02:59Z
• Authors: Michel Gagner; Guy-Bernard Cadiere; Andres Sanchez-Pe...; David Abuladze; Todd Krinke; J. N. Buchwald; Nathalie Van Sante; Marc Van Gossum; Jana Dziakova; Levan Koiava; Maja Odovic; Mathilde Poras; Lamees Almutlaq; Antonio J. Torres
• Keywords: Adult; Male; Obesity; Sleeve gastrectomy; Duodenum; Gastric Bypass; Magnetic compression anastomosis; 32 Ciencias Médicas; Gastrectomy; Weight Loss; 617; Humans; Obesity; Sleeve gastrectomy; Chirurgie; Retrospective Studies; 2. Zero hunger; Duodeno-ileostomy; Anastomosis, Surgical; Magnet system; Type 2 diabetes; 3. Good health; Obesity, Morbid; 2023 SAGES Oral; Ciencias Biomédicas; Diabetes Mellitus, Type 2; Metabolic/bariatric surgery; Magnets; Female

Abstract Introduction Gastrointestinal anastomoses with classical sutures and/or metal staples have resulted in significant bleeding and leak rates. This multi-site study evaluated the feasibility, safety, and preliminary effectiveness of a novel linear magnetic compression anastomosis device, the Magnet System (MS), to form a side-to-side duodeno-ileostomy (DI) diversion for weight loss and type 2 diabetes (T2D) resolution.

Methods In patients with class II and III obesity (body mass index [BMI, kg/m2] ≥ 35.0– ≤ 50.0 with/without T2D [HbA1C > 6.5%]), two linear MS magnets were delivered endoscopically to the duodenum and ileum with laparoscopic assistance and aligned, initiating DI; sleeve gastrectomy (SG) was added. There were no bowel incisions or retained sutures/staples. Fused magnets were expelled naturally. Adverse events (AEs) were graded by Clavien-Dindo Classification (CDC).

Results Between November 22, 2021 and July 18, 2022, 24 patients (83.3% female, mean ± SEM weight 121.9 ± 3.3 kg, BMI 44.4 ± 0.8) in three centers underwent magnetic DI. Magnets were expelled at a median 48.5 days. Respective mean BMI, total weight loss, and excess weight loss at 6 months (n = 24): 32.0 ± 0.8, 28.1 ± 1.0%, and 66.2 ± 3.4%; at 12 months (n = 5), 29.3 ± 1.5, 34.0 ± 1.4%, and 80.2 ± 6.6%. Group mean respective mean HbA1C and glucose levels dropped to 1.1 ± 0.4% and 24.8 ± 6.6 mg/dL (6 months); 2.0 ± 1.1% and 53.8 ± 6.3 mg/dL (12 months). There were 0 device-related AEs, 3 procedure-related serious AEs. No anastomotic bleeding, leakage, stricture, or mortality.

Conclusion In a multi-center study, side-to-side Magnet System duodeno-ileostomy with SG in adults with class III obesity appeared feasible, safe, and effective for weight loss and T2D resolution in the short term.