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Repair of esophageal atresia with proximal fistula using endoscopic magnetic compression anastomosis (magnamosis) after staged lengthening

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Abstract

We describe the treatment of a patient with long-gap esophageal atresia with an upper pouch fistula, mircogastria and minimal distal esophageal remnant. After 4.5 months of feeding via gastrostomy, a proximal fistula was identified by bronchoscopy and a thoracoscopic modified Foker procedure was performed reducing the gap from approximately 7–5 cm over 2 weeks of traction. A second stage to ligate the fistula and suture approximate the proximal and distal esophagus resulted in a gap of 1.5 cm. IRB and FDA approval was then obtained for endoscopic placement of 10-French catheter mounted magnets in the proximal and distal pouches promoting a magnetic compression anastomosis (magnamosis). Magnetic coupling occurred at 4 days and after magnet removal at 13 days an esophagram demonstrated a 10 French channel without leak. Serial endoscopic balloon dilation has allowed drainage of swallowed secretions as the baby learns bottling behavior at home.

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Acknowledgments

Cook Medical provided the device used in this patient.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Women and Children’s Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA

    Robert M. Dorman, Kaveh Vali, Carroll M. Harmon & Kathryn D. Bass

  2. Department of Surgery, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY, 14203, USA

    Robert M. Dorman, Kaveh Vali, Carroll M. Harmon & Kathryn D. Bass

  3. Department of Radiology, The University of Chicago Medicine, Comer Children’s Hospital, 5721 S. Maryland Avenue, Chicago, IL, 60637, USA

    Mario Zaritzky

Authors
  1. Robert M. Dorman
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  2. Kaveh Vali
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  3. Carroll M. Harmon
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  4. Mario Zaritzky
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  5. Kathryn D. Bass
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Corresponding author

Correspondence to Robert M. Dorman.

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Disclosures

Dr. Zaritzky is an advisor and proctor for Cook Medical, and shares the patent and future royalty payments pending catheter-based magnetic device commercialization. The other authors have no relevant disclosures.

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Dorman, R.M., Vali, K., Harmon, C.M. et al. Repair of esophageal atresia with proximal fistula using endoscopic magnetic compression anastomosis (magnamosis) after staged lengthening. Pediatr Surg Int 32, 525–528 (2016). https://doi.org/10.1007/s00383-016-3889-y

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  • DOI: https://doi.org/10.1007/s00383-016-3889-y

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