Comparative early histologic healing quality of magnetic versus stapled small bowel anastomosis.

BACKGROUND: Successful anastomotic healing is critical to preventing complications after intestinal surgery. We aimed to compare the early healing of end-to-end small bowel anastomosis by self-forming magnets with surgical stapling in a porcine model. METHOD: Six Yorkshire pigs underwent 2 simultaneous small bowel anastomoses using a circular stapler and self-forming magnet technique. The primary outcome was healing quality, measured by 4 histologic features: inflammatory cell infiltration, collagen formation, grade of inflammation, and bacterial infiltration at the anastomosis. The samples were evaluated at days 1, 3, and 7. Gross evaluation of anastomotic integrity was a secondary outcome. RESULTS: The self-forming magnet group displayed significant differences at each time point. On day 1, the stapled group displayed dense inflammatory cell infiltration and extensively ulcerated intestinal layers with significant edema. The self-forming magnet group showed less inflammatory infiltrate, and all intestinal layers remained compressed in direct apposition. By day 3, the self-forming magnet group already exhibited neovascularization with scant bacterial colonies. By contrast, stapled anastomoses had large areas of inflammation separating collagen fibers with prevalent bacterial infiltrations. On day 7, self-forming magnet anastomoses were characterized by robust neovascularization, maturing granulation tissue, and mucosal re-epithelization without significant inflammation. Meanwhile, stapled samples had persisting dense inflammation, tissue cavities with hemorrhage, and immature fibrous tissue. Grossly, the self-forming magnet created a patent lumen without defect, whereas stapled anastomoses demonstrated focal areas of serosal separation. CONCLUSION: Bowel anastomosis by self-forming magnets is associated with superior early histologic healing metrics, including early seal generation through mechanical compression, decreased inflammation, early neovascularization, lower bacterial infiltration, and faster re-epithelization.

Transcervical wedge resection after transcervical extended mediastinal lymphadenectomy.

Transcervical extended mediastinal lymphadenectomy (TEMLA) has been shown to be feasible and safe. This approach may be underrecognized for providing excellent access to the pleural space. We present a 60-year-old woman who had a clinical stage T2b N0 M0 adenocarcinoma of her right lower lobe and several ground glass opacities throughout her upper lobes bilaterally. She underwent a TEMLA to confirm absence of lymph node involvement in her mediastinum. During the same anesthetic setting, a transpleural right upper lobe wedge resection via the cervical approach was performed as an extension of her TEMLA. The pathology from this wedge resection demonstrated atypical adenomatous hyperplasia. Ultimately, she underwent a thoracoscopic right lower lobectomy that confirmed that she had a pathologic T2b N0 M0 (5.0 × 4.0 × 3.0 cm) adenocarcinoma. There were no perioperative adverse events with either operation. Transcervical extended mediastinal lymphadenectomy and transcervical lung resections may be performed safely during the same anesthetic setting.