Abstract
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.
Graphical abstract

Graphical Abstract
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Article info
Publication history
Published online: December 22, 2022
Accepted:
November 21,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.