Recently, a patient presenting with rectal anastomotic atresia after rectal cancer surgery was successfully treated in Department of Hepatobiliary Surgery (special surgery) in Land Port Division of the First Affiliated Hospital (FAH) of Xi’an Jiaotong University (XJTU). About 11 months ago, the patient underwent radical resection of rectal cancer and preventive ileostomy. When the ileostomy was performed two months ago, rectal anastomotic atresia was identified. Because of anastomotic atresia, it is challenging to perform endoscopic balloon dilatation treatment. He received no effective treatment in multiple hospitals, and finally sought for treatment in Department of Hepatobiliary Surgery of Land Port Division of FAH.
After receiving the consultation, physician Yan Xiaopeng from Department of Hepatobiliary Surgery further performed colonography to confirm the diagnosis of rectal anastomotic atresia, and the atresia was approximately 1 cm long. According to previous experience of the magnetic surgery team in treating rectal anastomotic stenosis/atresia, it is necessary to deliver the daughter magnet to the upper end of rectal atresia segment through stoma under colonoscopy. However, the patient developed intestinal perforation recently. Although symptoms were mitigated after conservative treatment, colonoscopy in such a short period of time is likely to cause repeated perforation, leading to recurrence or even aggravation.
Professor Lyu Yi conducted consultation with deputy chief physician Sha Huanchen, physician Yan Xiaopeng and PhD. Zhang Miaomiao to carefully evaluate the illness and intestinal condition, the endoscope-free magnet implantation was determined. Specifically, the daughter magnet was directly placed through the stoma and make it reach the upper end of rectal atresia by intestinal peristalsis. At present, the magnetic recanalization surgery for rectal stricture/atresia reported at home and abroad adopts the method of placing magnets under endoscope, and there is no clinical case for reference for endoscope-free magnet placement. To ensure the safety of this patient, physician Yan Xiaopeng designed a traction wire on the magnet to control the magnet more accurately, and also proposed a regimen of magnetic navigation to assist magnet movement.
After the regimen was determined, physician Yan Xiaopeng and PhD. Zhang Miaomiao placed a circular magnet with a diameter of 20 mm through the ileostomy. After taking a series of measures to accelerate the magnet movement in the intestine, X-ray showed that the magnet had reached above the rectal atresia 3 days later. Then, after the parental magnet was successfully placed through the anus, the daughter magnet and parental magnets at both ends of the rectal atresia were precisely aligned and attracted.
After 17 days, the daughter and parental magnet was successfully taken out through the anus, and the rectal atresia was recanalized. Deputy chief physician Yin Yan from Department of Gastroenterology performed anorectal examination to confirm that the magnetic anastomosis had been established.
Recently, the project entitled "Treatment of refractory anastomotic stenosis with magnetic anastomosis technique" by magnetic surgery team was successfully selected as one of Top 10 advances in the field of digestive endoscopy in 2024 by China Medical News, which fully demonstrated high recognition of the innovative technology of magnetic surgery team by national peers and colleagues.
