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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Choledochojejunostomy with an innovative magnetic compressive anastomosis: How to determine optimal pressure?
Fei Xue, Hong-Chang Guo, Jian-Peng Li, Jian-Wen Lu, Hao-Hua Wang, Feng Ma, Ya-Xiong Liu, Yi Lv
Fei Xue, Jian-Peng Li, Jian-Wen Lu, Yi Lv, Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Fei Xue, Jian-Peng Li, Jian-Wen Lu, Hao-Hua Wang, Feng Ma, Yi Lv, XJTU Research Institute of Advanced Surgical Technology and Engineering, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Fei Xue, Jian-Peng Li, Jian-Wen Lu, Hao-Hua Wang, Feng Ma, Yi Lv, Regenerative Medicine and Surgery Engineering Research Center of Shaanxi Province, Xi’an 710061, Shaanxi Province, China
Hong-Chang Guo, Ya-Xiong Liu, School of Mechanical Engineering, Xi’an Polytechnic University, Xi’an 710048, Shaanxi Province, China
Hong-Chang Guo, Ya-Xiong Liu, State Key Laboratory of Mechanical System Engineering, Xi’an 710049, Shaanxi Province, China
Author contributions: Xue F, Liu YX and Lv Y conceived and designed the research; Xue F and Liu YX observed the magnets; Xue F, Li JP, Lu JW and Guo HC performed the research; Xue F, Li JP and Lu JW acquired the data; Xue F, Guo HC, Wang HH and Ma F performed histological studies; Xue F and Lv Y wrote the draft and made critical revisions related to the intellectual content of the manuscript, and approved the final version of the article to be published.
Supported by the National Natural Science Foundation of China, No. 51275387; the Project of Development and Innovation Team of Ministry of Education, No. IRT1279; and the Science and Technology Co-ordination and Innovation Project, Shaanxi Province of China, No. 2011KTCQ03-12.
Institutional review board statement: The entire study was carried out in strict accordance with protocols approved by the Xi’an Jiaotong University Biomedical Ethics Committee (Ethics Permit No. XJTULAC201-398).
Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Xi’an Jiaotong University Institutional Care and Use Committee, and performed according to the Guidelines for Animal Experimentation of Xi’an Jiaotong University (SYXK-SHAN 2014-003) and the Guide for the Care and Use of Laboratory Animals Published by the US National Institutes of Health.
Conflict-of-interest statement: The authors report no declarations of interest. Yi Lv has received research funding from the Ministry of Education of China and the Science and Technology Co-ordination and Innovation Project of Shaanxi province of China. Ya-Xiong Liu has received research funding from the National Natural Science Foundation of China. Hao-Hua Wang and Feng Ma are the employees in professor Lv’s research group. Fei Xue, Jian-Peng Li and Jian-Wen Lu are the graduate students professor Lv’s research group in Xi’an Jiaotong University. Hong-Chang Guo is the graduate student in Xi’an Polytechnic University and a member in professor Liu’s research group.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at luyi169@126.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yi Lv, MD, PhD, Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi’an Jiaotong University, No. 277 West Yan-ta Road, Xi’an 710061, Shaanxi Province, China.
luyi169@126.com
Telephone: +86-29-82657541 Fax: +86-29-85323900
Received: June 4, 2015
Peer-review started: June 6, 2015
First decision: September 29, 2015
Revised: October 18, 2015
Accepted: December 12, 2015
Article in press: December 12, 2015
Published online: February 21, 2016
Processing time: 241 Days and 6.6 Hours
AIM: To investigate the optimal magnetic pressure and provide a theoretical basis for choledochojejunostomy magnetic compressive anastomosis (magnamosis).
METHODS: Four groups of neodymium-iron-boron magnets with different magnetic pressures of 0.1, 0.2, 0.3 and 0.4 MPa were used to complete the choledochojejunostomy magnamosis. Twenty-six young mongrel dogs were randomly divided into five groups: four groups with different magnetic pressures and 1 group with a hand-suture anastomosis. Serum bilirubin levels were measured in all groups before and 1 wk, 2 wk, 3 wk, 1 mo and 3 mo after surgery. Daily abdominal X-ray fluoroscopy was carried out postoperatively to detect the path and the excretion of the magnet. The animals were euthanized at 1 or 3 mo after the operation, the burst pressure was detected in each anastomosis, and the gross appearance and histology were compared according to the observation.
RESULTS: The surgical procedures were all successfully performed in animals. However, animals of group D (magnetic pressure of 0.4 MPa) all experienced complications with bile leakage (4/4), whereas half of animals in group A (magnetic pressure of 0.1 MPa) experienced complications (3/6), 1 animal in the manual group E developed anastomotic stenosis, and animals in group B and group C (magnetic pressure of 0.2 MPa and 0.3 MPa, respectively) all healed well without complications. These results also suggested that the time required to form the stoma was inversely proportional to the magnetic pressure; however, the burst pressure of group A was smaller than those of the other groups at 1 mo (187.5 ± 17.7 vs 290 ± 10/296.7 ± 5.7/287.5 ± 3.5, P < 0.05); the remaining groups did not differ significantly. A histologic examination demonstrated obvious differences between the magnamosis groups and the hand-sewn group.
CONCLUSION: We proved that the optimal range for choledochojejunostomy magnamosis is 0.2 MPa to 0.3 MPa, which will help to improve the clinical application of this technique in the future.
Core tip: This study introduced a magnetic anastomosis device and verified the feasibility of magnetic compression anastomosis (magnamosis) in choledochojejunostomy; moreover, 3D printing technology was used to design and produce magnetic shells of different sizes to explore the optimum magnetic pressure range in choledochojejunostomy. The result of this study provided a more efficient and accurate theoretical basis for clinical application of choledochojejunostomy magnamosis in the future.
