Esophageal magnetic anastomosis for long gap congenital esophageal atresia: A case report

Rationale:Long gap esophageal atresia (LGEA) is a rare congenital malformation. Magnamosis represents a minimally invasive technique for LGEA to achieve esophageal recanalization for feeding. Few cases had been reported worldwide. Patient concerns:An infant was diagnosed as congenital esophageal atresia by using prenatal ultrasound imaging including the absence of gastric bubble and polyhydramnios. Diagnoses:LGEA was confirmed after birth by esophagography through the gastrostomy and esophagus simultaneously. Interventions:Laparoscopic gastrostomy was performed on the 3rd day after birth to obtain nutrition. The esophagus was prolonged from the proximal and distal blind end weekly starting from 2 weeks after gastrostomy. Magnamosis was achieved with the help of thoracoscopy. The proximal and distal esophagus were fully separated and released under thoracoscopy. Two magnets were introduced into the proximal and distal esophageal pouch respectively. Chest X-rays were performed to demonstrate a progressive reduction of inter magnetic space. The esophageal imaging confirmed that the esophagus is connected, and the magnets were removed from mouth. An anastomotic leak was found, and the leak healed within 2 weeks. Outcomes:The infant achieved esophageal recanalization through magnetic anastomosis, allowing for oral feeding and maintained her native esophagus. Esophageal stenosis occurred at 4 weeks after magnetic anastomosis without other complications. Endoscopic balloon dilation was performed. The infant was followed up for 6 months, and exhibited durable esophageal patency with a good nutrition. Lessons:This result suggests that magnetic anastomosis is a feasible and effective treatment for LGEA in infants.