The world’s first surgery to restore the continuity of the esophagus with the use of magnets in a 17-month-old child was performed at the University Children’s Hospital in Krakow-Prokocim by a pediatric surgeon, Assoc. Adam Bysiek with the team.
The procedures of restoring the length and then anastomosis of the esophagus were performed in a 17-month-old child with an extremely severe form of congenital hypoplasia of the esophagus (the so-called long-distance interval). The increase in the length of the tissues of the underdeveloped organ was caused by the application of mechanical forces for several days, obtained by the interaction of strong permanent magnets.
The original method of Krakow doctors will be presented in October at the World Congress of Pediatric Surgeons in Delhi, Dr. Adam Bysiek.
Congenital oesophageal obstruction is one of the most severe and difficult to treat malformations in newborns. It consists in the fact that the esophagus, i.e. the muscular tube that connects the throat with the stomach, has a broken continuity – said Assoc. Adam Bysiek. As he explained, the upper section ends blindly, and the lower section takes on various anatomical forms – it is closed or fused with other organs.
The long-segmented form of esophageal obstruction occurs in about 5-10%. children with this defect. Since it is impossible to immediately perform an anastomosis and restore the continuity of the esophagus, the child is doomed to create a gastric fistula (gastrostomy) by surgical implantation of a catheter for feeding food directly into the stomach, and at the same time continuous suction of saliva from the upper part of the blind esophagus with a special pump. This is to prevent saliva from entering the trachea, putting the child in a fatal situation of choking.
The procedure was performed on a child whose esophagus was approximately 65 mm between the blind and the lower esophagus. This distance is too great to perform the classic, complicated tensed esophageal anastomosis surgery.
It was not possible to plan other extensive emergency surgeries, used by us in such situations (transfer of the stomach or part of the intestine to the chest), due to the large abdominal surgeries previously performed by the child due to other associated defects of the gastrointestinal tract – said Assoc. Adam Bysiek. Regardless of this, they are the so-called esophageal substitutes, compulsory and imperfect solutions, burdened with many dangers resulting from the failure of these tissues to adapt to the functions performed by the esophagus for many years, the surgeon explained.
Over the past several decades, attempts have been made to extend both sections of the esophagus, e.g. with the help of silver balls inserted after opening the chest to the ends of both sections and attracted to each other with a thread or a huge electromagnet, into which the whole child was inserted with metal tips in the esophagus. Both methods turned out to be too complicated, burdened with the risk of complications and abandoned after a few attempts.
Attempts of anastomosis only with the use of magnets inserted into both ends of the obstructed esophagus were described at the beginning of this year. in the world medical press, three doctors from Argentina. However, they were performed with a small distance of approx. 25 mm, so in forms that could be performed with classic surgical treatment, as the authors themselves write about.
In the case of a 17-month-old boy with a gap close to 70 mm, Assoc. Bysiek decided to use small neodymium magnets of extraordinary strength. It turned out, however, that with such a diameter of the magnets as possible for insertion into the esophagus, and with the distance separating them, the appropriate force of attraction of the tips cannot be obtained.
After appropriate calculations, the doctors decided to stimulate the growth of the lower esophagus with a magnet placed in it, using a large magnet placed outside – at the child’s neck. The strength of the external magnet was adjusted by calculation; after adding more circles of the magnet, the boy looked as if he had a can of Coca-Cola attached to his shoulder.
Progress in esophageal growth was monitored using X-rays. After adequate growth of the lower esophagus was achieved, doctors replaced the outer magnet with a neodymium disc, inserted through the mouth, without opening the chest, to the end of the upper esophagus. A new longer magnet was inserted into the lower segment, also without surgery, through the opening of the gastrostomy (gastric fistula). In this way, both sections of the esophagus were stimulated in the right direction to grow faster by two neodymium magnets attracting each other. The force of attraction was controlled all the time so that the magnets would not stick to each other, damaging the esophagus.
In the final step of the extension, the magnets stuck together. The endings of the two episodes between them died within a few days, and the walls of the esophagus fused together. The joined magnets were pulled from the esophagus, which is functioning normally. The entire procedure took two months.
We used a new idea, referring to solutions that were implemented years ago, but did not work. As in all science, thanks to the overall progress, you can do something new, creatively developing the ideas of your predecessors – said Assoc. Bysiek.
The operation according to the innovative method had to be approved by the ethics committee of the Jagiellonian University. The child’s parents also gave their consent.
The decision was easy, because there was nothing else to do, the boy’s mother told PAP. We were aware that there was a risk, but we knew that this was the only chance to improve our child’s life. We could only appreciate that the doctor could help him. We are very happy because we are finally at home, like a family, instead of in a hospital – she emphasized.
The method was proprietary to such an extent that the neodymium magnets by Assoc. Bysiek bought them at an online auction and secured them with a synthetic resin coating himself, so that neodymium would not enter into chemical reactions in the child’s body. Such magnets are known to the controllers of electric and gas meters; they serve, among others to falsify readings by dishonest recipients.
Another patient at the University Children’s Hospital in Kraków-Prokocim will probably undergo a similar operation. (PAP)