ABSTRACT
In recent years, with the development of organ preservation, surgical techniques, perioperative management and immunosuppression regimens, the success rate of liver transplantation and survival rate of the recipients have been significantly enhanced. Liver transplantation has become the optimal treatment for patients with end-stage liver disease. However, biliary complications still commonly occur after liver transplantation, especially biliary anastomotic stricture. Severe biliary anastomotic stricture will not only increase the cost of treatment, but also lead to graft loss and even affect the survival rate of recipients. Therefore, timely diagnosis and treatment of biliary anastomotic stricture play a significant role in improving the survival rate of liver transplant recipients. In this article, the risk factors, clinical symptoms, diagnosis and treatment of biliary anastomotic stricture after liver transplantation were reviewed, aiming to provide novel ideas for the research, diagnosis and treatment of biliary anastomotic stricture after liver transplantation, and further enhance clinical efficacy of liver transplantation and the quality of life of recipients.
ABSTRACT
【Objective】 Digestive tract reconstruction after total gastrectomy is complicated and causes many complications. This study aimed to investigate the feasibility, safety and effectiveness of magnetic compression anastomosis (MCA) for sutureless reconstruction after total gastrectomy in rats. 【Methods】 Twenty-four rats were randomly apportioned to two groups. Reconstruction was performed with MCA in the experimental group or hand-sewn in the control group, and the construction time was recorded. The animals were followed up for 30 days. The survival rate and complications were monitored. At each time point, the rats were euthanized to study the gross/histological morphology and mechanical strength of the anastomoses. 【Results】 The reconstruction time was (12.9±2.7)min in the experimental group and (23.8±4.1)min in the control group (P=0.036). In the experimental group, there was no anastomotic complication. Four control rats developed anastomotic leakage or hemorrhage, and all died within 4 postoperative days. Compared with the control group, burst pressure in the experimental group was similar. Both groups’ anastomoses had smooth gross appearance and histologically good alignment of tissue layers. 【Conclusion】 MCA is a safe and effective choice for reconstruction after total gastrectomy, with better postoperative outcomes than hand-sewn.
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Clinical cases treated by magnetic compression anastomosis (MCA) for different causes and types of intestinal stenosis/ atresia to successfully achieve intestinal recanalization were reviewed, so as to explore the clinical application of MCA. From May 2019 to August 2022, 4 patients underwent colorectal MCA for intestinal recanalization in the First Affiliated Hospital of Xi'an Jiaotong University and Northwest Women and Children's Hospital. All operations went well, and the intestinal anastomosis was recanalized. The magnetic ring was discharged in 7-15 days, and the postoperative colonoscopy or radiography showed that the anastomosis was intact. MCA can be used to treat different types of colorectal stenosis and atresia due to different reasons, and can also be used to assist intestinal anastomosis in colorectal surgery.
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Objective To explore the feasibility of rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis (MCA) technique. Methods Twelve healthy adult crossbred dogs were evenly divided into the MCA and hand suturing (HS) groups according to the anastomosis method between abdominal aorta and artificial blood vessels. The intraoperative duration of abdominal aorta occlusion, intraoperative condition of anastomotic stoma and postoperative imaging examination of anastomotic stoma were compared between two groups. Results The intraoperative duration of abdominal aorta occlusion in the MCA group was significantly shorter than that in the HS group [(5.2±2.3) min vs. (24.4±4.3) min, P < 0.001]. No anastomotic leakage of blood or anastomotic stenosis occurred in the MCA group during the operation. Intraoperative anastomotic leakage of blood occurred in all of the 6 dogs in the HS group. Among them, 1 dog died of excessive blood loss, and 2 dogs experienced mild anastomotic stenosis due to repeated repair. Postoperative color Doppler ultrasound and angiography showed smooth blood flow at the anastomotic stoma without stenosis or thrombosis in the MCA group. In the HS group, 4 dogs presented with anastomotic stenosis on angiography at postoperative 4 weeks. Conclusions MCA technique may achieve rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models, which reduces the incidence of anastomotic complications and accelerates postoperative recovery.
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Objective:To invent a set of novel magnetic anastomotic device based upon the technique of magnetic compression anastomosis(MCA)for rapid venous reconstruction during ex situ liver resection, and verify its clinical value and performance in animal models. Methods:Fiften adult mongrel dogs of either gender underwent the ex situ liver resection. The novel magnetic vessel anastomosis device for the venous reconstruction of liver autotransplantation procedure was performed on 8 mongrel dogs(MCA group), and the traditional handsewing technique was used on 5 additional dogs(THS group). Time for completing venous reconstruction and time of venous anastomosis, venous velocity, intraoperative and postoperative survival and complications were recorded. Patency was detected via color Doppler ultrasound scans and X-ray cholangiography after surgery. The changes of intestinal lumen and kidney were also observed. Results:The time required to perform IVC and PV reconstruction for liver autotransplantation was significantly shorter for the magnetic vessel anastomosis device(9.5±2.5) min than for THS(30.7±3.4) min. There was significant difference in anhepatic period( P=0.0000). After operation, except one died, other nine animals in group A survived after operation but all five cases died in the THS group during liver autotransplantation. Vascular X-ray angiography and color Doppler ultrasound found blood flow MCA group normal, and there wasn't stoma stenosis. Conclusions:MCA technique could be fast and efficacious to complete venous reconstruction for liver autotransplantation in ex situ liver resection operation, and helpful to reduce organ ischemia-reperfusion injury.
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【Objective】 To evaluate the performance of the magnetic artificial blood vessel device for fast non-suture anastomosis of caval reconstruction with artificial blood vessel transplantation after resection in canines. 【Methods】 Sixteen adult mongrel dogs of either gender were randomly divided into two groups for vena cava reconstruction with artificial blood vessel transplantation after inferior vena cava (IVC) resection. Group MCA (n=8): magnetic artificial blood vessel device for IVC reconstruction; Group manual sewing (MS) (n=8): hand suturing for IVC reconstruction. Operation time and stoma errhysis were recorded during operation. Patency and stoma stenosis were confirmed via color Doppler ultrasound scanning and X-ray cholangiography at different time points as late as 4 weeks after surgery. 【Results】 The time required to perform the vascular anastomosis was significantly shorter for the magnetic artificial blood vessel device (6.25±2.25)min than for MS (27.32±5.12)min (P<0.001). There were four cases of stoma errhysis in MS group which had to be repaired (P=0.077). Vascular X-ray angiography and color Doppler ultrasound found normal blood flow and no stoma stenosis in MCA group, but three cases of stoma stenosis in MS groups (P=0.200). Compared with MS group, the magnetic ring device stoma was associated with smooth re-endothelialization and depressed infiltration of inflammatory cells at the anastomotic site. 【Conclusion】 The magnetic artificial blood vessel device offers a simple, fast, reliable, and efficacious technique for vena cava reconstruction with artificial blood vessel transplantation.
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Objective To study the safety and efficacy of magnetic compression anastomosis (MCA) in treatment of biliary anastomotic stricture after orthotopic liver transplantation (LT).Methods Five patients who were treated unsuccessfully by ERCP were admitted to The First Affiliated Hospital of Xi'an Jiaotong University from 2012 January to 2018 May to undergo MCA.The treatment results were analyzed retrospectively.Results In four patients,the treatment was successful while in one patient it failed.For the four successful patients,the biliary stricture length was 2～4 mm.Re-canalization was achieved within 7～12 days and these patients were discharged home without any adverse events.Multiple plastic stents (in 2 patients) or full-covered self-expansion mental stents (in 2 patients) were inserted into the new fistulae after re-canalization.In two patients whose stents were removed,there was no recurrence of biliary strictures after follow-up for 64 months and 59 months,respectively.Conclusion The MCA technique is a revolutionary and effective method of performing interventional choledochocholedochostomy in patients with biliary anastomotic stricture after LT for whom the conventional endoscopic procedures were not successful.
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Magnetic compression anastomosis (MCA)involves the use of two rare-earth magnets that attract to each other transmurally between two internal organs, resulting in compression and subsequent fistula formation to create a nonsurgical enteric, vascular, or biliary anastomosis with therapeutic aims. The magnetic vascular coupler allows a sutureless anastomoses between arteries and veins by using interventional radiological techniques. The MCA technique significantly reduces ischemic time during anastomosis, and has the advantages of low invasiveness and simplicity. It is a rather effective method for recanalizing between various hollow viscera, creating anastomosis such as gastrojejunostomy, choledochojejunostomy, or choledochoduodenostomy.Furthermore, this novel technique is considered to be a feasible and alternative reconstructive method for patients who develop significant bile duct complications following hepaticojejunostomy and living donor liver transplantation. MCA is a promising and novel technique in the further development of minimal invasive surgery.
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Objective To explore a new method for one-stage repair of the intestinal leakage based on the principle of magnetic compression anastomosis. Methods Twenty-four dogs were randomly divided into experimental group (n = 12) and control group (n = 12) according to random number table. The model of upper and multiple intestinal leakages was established by making transverse incisions of 1 cm in length on the jejunum wall about 50 cm and 100 cm away from the Treitz ligament. Forty-eight hours later, two NdFeB magnetic rings with the magnetic flux of 2500 G were put into the intestine from the leak sites. The leak sites were pressed between the two rings. The ventages in the control group were sutured. The condition of the dogs was observed after the repair of the leakage. The excreting time was recorded, and the leakage pressures of the anastomotic stoma were detected.The positions of the magnetic rings in the experimental group were detected by X ray. Tissues of the anastomotic stoma were processed by hematoxylin eosin and Masson staining. All data were analyzed using the two-sample t test. Results Severe abdominal infection occurred 48 hours after the establishment of the model. All the intestinal leakages in the experimental group were successfully repaired and the dogs survived for a long time. The magnetic rings were excreted six or seven days after the repair. Eight dogs of the control group survived. The leakage pressure of the anastomotic stoma seven days after the repair was (134 ±23)mm Hg (1 mm Hg =0. 133 kPa) in the experimental group and (91 ± 18)mm Hg in the control group, respectively, with a significant difference between the two groups (t = 3.225, P ＜ 0.05). The leakage pressure of the anastomotic stoma 14 days after the repair was (281 ±7)mm Hg in the experimental group and (271 ±21) mm Hg in the control group, respectively, with no significant difference between the two groups (t =0. 988, P ＞ 0.05). Histological observation showed that after the magnetic compression anastomosis, the intestinal muscle and mucosa recovered well, inflammatory reaction was slight and less collagen fiber and scar was formed. Conclusions Application of magnetic ring with the magnetic flux of 2500 G in one-stage repair of the intestinal leakage in the state of severe abdominal infection is safe and reliable.
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Magnetic compression anastomosis (MCA) is a minimally invasive method of performing choledochocholedochostomy without surgery in patients with biliary stricture or obstruction. We describe a successful case involving magnetic compression duct-to-duct biliary reconstruction in right-lobe living donor liver transplantation (RL-LDLT). Endoscopically, a samarium-cobalt (Sm-Co) rare-earth magnet was placed at the superior site of obstruction via the percutaneous transhepatic biliary drainage route, and another Sm-Co magnet was also placed at the inferior site of obstruction with the aid of an endoscope. MCA techniques enabled complete anastomosis without procedure-related complications. In conclusion, the MCA technique is a revolutionary method of performing choledochocholedochostomy in patients with biliary obstruction after LDLT.