It is called magneto-anastomosis. It is the innovative technique used for the first time in Italy by the doctors at Bambino Gesù Children’s Hospital to treat esophageal atresia, a rare congenital malformation that involves the lack of a tract of the esophagus and prevents normal feeding through the mouth in newborns. Thanks to the action of two magnets, positioned at the ends of the esophageal stumps, it is possible to restore the continuity of the esophagus without resorting to surgery. The first 5 children treated by the Hospital, all aged below 4 months, were described in the Journal of Pediatric Surgery. To date, only 25 cases are described in the literature worldwide.
ESOPHAGEAL
ATRESIA
Esophageal atresia is a malformation characterized by an interruption of the esophagus, the tract of the digestive tract that allows the passage of food from the mouth to the stomach. It is a rare congenital anomaly, of unknown causes, whose frequency ranges from a maximum of 1 child in 2500 to a minimum of 1 child in 4000 live births.
In many cases, esophageal atresia is associated with the presence of abnormal communication (tracheoesophageal fistula) with the trachea. In a minority of cases, about 10-15% of the total, the abnormal communication with the trachea is not present, but the distance between the two stumps of the esophagus is greater. In this case, reference is made to long-gap esophageal atresia.
Both variants of esophageal atresia are usually treated in the first months of life with very effective surgical interventions, which however show the well-known and inherent risks of this specific technique, as well as the general ones linked to a chest surgery in a newborn or an infant weighing a few kilos.
THE NEW
TECHNIQUE
Magneto-anastomosis is an innovative and non-invasive technique that allows to treat esophageal atresia without a traditional surgery. This applies to its less common variant, the one without tracheo-esophageal fistula, also known as “long- gap”. It is carried out by placing the magnets, two 0.5 cm diameter magnets, in the end part of the two non-communicating stumps of the esophagus. One is positioned in the upper stump by using a soft probe and passing through the mouth; the other is positioned in the lower stump by passing another similar probe through a small feeding opening in the stomach. Infants with long-gap esophageal atresia, in fact, must be temporarily fed artificially until the problem is solved.
Once the magnets are positioned, the two stumps of the esophagus are pushed towards each other under radioscopic guidance, until they get close enough to attract each other and join based on the force generated by the magnetic field. The operation lasts on average about one hour compared to 2/4 hours of the traditional surgical technique. Within about a week, the pressure exerted by the magnets “erodes” the walls of the esophagus, opening the passage between the upper and lower stump. At the same time, thanks to the prolonged contact, the two stumps weld together. At this point the esophagus is “seamless” and “patent”, that is, open and no longer “atresic”.
At the end of this process, the two magnets are removed simply by removing the soft probe on which they were positioned. The child is immediately re-fed orally and subjected to some esophageal dilation sessions (as it happens when using the traditional surgical technique) to allow it to have adequate width even for the passage of food thicker than milk.
INFANTS TREATED TO
THE BAMBINO GESÙ HOSPITAL
The cases of the first 5 patients treated in Italy at Bambino Gesù with the innovative minimally invasive technique – all infants aged less than 4 months – have been described in the Journal of Pediatric Surgery. The 5 children are doing well and have returned home after the procedure with magnets. To date, 8 children have been treated at the Hospital of the Holy See, all of which are under the age of 6 months: 3 from Lazio, 2 from Puglia, 1 from Calabria, 1 from Sicily and 1 from Lombardy.
«The advantages of this new technique are manyfold – explains Professor Pietro Bagolan, director of the fetus-newborn-infant medical-surgical department. In addition to avoiding stress and the possible consequences (post-op pain, surgical wound, etc.) of a traditional or minimally invasive thoracoscopic surgery, children also have a much simpler and faster course before they can eat naturally through their mouth. Furthermore, no scars are left, not even internal ones, as it happens with the traditional surgical access. This makes any future possible interventions easier and quicker, thanks to the absolute respect for the anatomy of the thorax and mediastinum, the delicate anatomical region in which the esophagus is located».
LIMITS AND
FUTURE PROSPECTS
Only 25 cases of magneto-anastomosis have been described to date in the international scientific literature. Too few to understand whether some post-surgery risks – such as stenosis, that is the danger of narrowing of the esophagus – are higher or lower than the traditional surgical technique. For this reason, an international multicentric study will soon be launched to develop and test new magnets specially patented for clinical use, which should be able to reduce this risk. The study will last about 2 years and will involve 6 centers worldwide including Bambino Gesù in Italy.
