Our Procedures

Technique: MAGNET System Side-to-Side Compression Anastomosis Duodeno-ileostomy

Technique: MAGNET System Side-to-Side Compression Anastomosis Gastrojejunostomy

The GT Metabolic Magnet System is currently for Investigational Use Only.

Side-to-Side Compression Anastomosis Using the GT Metabolic Solutions Magnetic Anastomosis System (MAGNET System) to Achieve Duodeno-Ileostomy Diversion in Adults

In clinical studies this year, a novel, less-invasive technique enabled us to change how we approach metabolic/bariatric surgery. Magnets were used to create  a duodeno-ileal (DI) anastomosis.  The anastomosis creates partial diversion of intestinal contents; this is intended to facilitate durable weight loss and improve glycemic control in obese patients with or without type 2 diabetes. A side-to-side DI can now be performed magnetically, with no bowel incisions.

Creation of the DI anastomosis utilizing the gradual compressive forces of two magnets is simpler than employing intraoperative cutting, suturing, or stapling of the duodenum and ileum. The magnets compress, necrose, and slough the tissue between them, forming the anastomosis gradually, over 7-21 days. During this time, the tissues around the magnets’ edges form a strongly sealed, patent anastomosis and duodeno-ileal diversion. After tissue compression, the magnets detach and are expelled naturally. This technique is elegant, minimally invasive, and reversible.

The DI magnetic surgery advancement:

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may decrease operative time

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may reduce bleeding

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may prevent leaks and fistulas, as the anastomosis is deferred

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may decrease malnutrition

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may permit day surgery

Our study of this approach is ongoing in current GT clinical trials. The initial studies have shown promising early safety and effectiveness results, and we believe we are moving in the right direction.

Technique: MAGNET System Side-to-Side Compression Anastomosis Duodeno-ileostomy

/01

Under general anesthesia, laparoscopically, a marker is placed in the ileum 250 cm from the cecum.

/02

A retrievable metal bowel clamp is placed 10-15 cm distal to the ligament of Treitz.

/03

The first (distal) magnet is transported orogastrically by flexible endoscopic catheter to the fourth part of the duodenum. The magnet is released in the proximal jejunum and is attracted toward the clamp.

/04

A positioning device is used to grasp the magnet, the clamp is removed, and the positioner directs the magnet through the jejunal lumen to the marked position in the ileum, 250 cm from the ileocecal valve. The endoscope is retracted to the level of the stomach.

/05

The first (distal) magnet in the ileum is elevated over the transverse colon with two non-magnetic bowel forceps and brought anterior and latero-lateral to the post-pyloric duodenum. The second (proximal) magnet is delivered through the endoscope to the intended magnet fusion site in the post-pyloric duodenum.

/06

The second (proximal) magnet is released to self-align with the first (distal) magnet through the intestinal walls. The endoscope and magnet positioning device are withdrawn. Petersen’s defect is closed.

/07

In several days, the two magnets are fully fused after compressing and sloughing the tissue between them. The magnets detach several weeks later from the duodeno-ileal site and are expressed naturally.

/08

Food flows through the duodenal lumen, and also through the patent anastomosis into the ileal lumen. The anastomosis is extremely durable after 3-4 weeks.

/09

After the procedure, patients are carefully monitored with special attention to hemodynamic conditions and cardiac rhythm for a minimum of 24 hours. Successful placement of the MAGNET System is confirmed radiologically by abdominal x-ray, and fluoroscopically, using barium or gastrographin on postoperative day 1. Patients meet with a dietician or nutritionist prior to discharge to review the post-procedure diet.

Illustrations by Christian Bogaert

Technique: MAGNET System Side-to-Side Compression Anastomosis Gastrojejunostomy

/01

Under general anesthesia, laparoscopically, titanium clip markers are placed at 150 cm on the mesentery of the proximal jejunum. Prior to gastroscopy, a retrievable metal bowel clamp is positioned 15 cm distal from the ligament of Treitz.

/02

The first (distal) magnet is transported orogastrically by flexible endoscopic catheter to the ligament of Treitz (first part of the jejunum). A positioning device is used to grasp the magnet, the bowel clamp is removed, and the positioner directs the magnet through the jejunal lumen to the marked position.

/03

The endoscope is retracted to the level of the stomach. The first (distal) magnet in the jejunum is elevated over the transverse colon with two non-magnetic bowel forceps and brought anterior and lateral to the lesser curvature of the stomach. The second (proximal) magnet is delivered through the endoscope to the intended magnet fusion site against the lesser curvature between the antrum and body of the stomach.

/04

The second/proximal (gastric) magnet is released to self-align with the first/distal (jejunal) magnet through the intestinal walls. The endoscope and magnet positioning device are withdrawn.

/05

The mesentery of the transverse colon and the mesentery of the jejunum (Petersen’s defect) are closed with a running non-absorbable suture to prevent a future internal hernia.

/06

In several days, the two magnets are fully fused after compressing and sloughing the tissue between them. Two to three weeks later, under positive gastric pressure, the magnets detach from the gastro-jejunal site and pass naturally.

/07

Food flows through the stomach, and also through the patent anastomosis into the jejunal lumen. The anastomosis is extremely durable after 3-4 weeks. Following the procedure, patients are carefully monitored with attention to hemodynamic conditions and cardiac rhythm for a minimum of 24 hours. Successful MAGNET System placement is confirmed radiologically by abdominal x-ray, and fluoroscopically, with barium or gastrographin on postoperative day 1. Patients meet with a dietitian or nutritionist prior to discharge to review the post-procedure diet.
Illustrations byMatthew D. Holt