Magnetic duodenoileal anastomosis with sleeve gastrectomy: a prospective multicenter study

Background: Magnetic digestive anastomosis has the potential to reduce anastomotic complications and complexity. We report the 1-year results of a new surgical technique using Self-forming Neodymium magnet Anastomosis Procedure with Sleeve gastrectomy (SNAP-S; GI Windows).

Methods: This was a prospective, nonrandomized multicenter trial. Participants with type 2 diabetes (T2D) who met criteria for metabolic surgery were recruited. A dual-path duodenoileal anastomosis was created at 300 cm from the ileocecal valve using circular magnetic anastomosis. The proximal magnet was deployed by endoscopy and the distal one by laparoscopy. Sleeve gastrectomy was performed at the same time. Data are reported as mean ± standard deviation or percentage.

Results: Nineteen subjects with T2D were recruited (age 45 ± 9 years, body mass index 43 ± 5 kg/m², hemoglobin A1C 7.3 ± 1.3%). There was no conversion, mortality, or adverse event related to the magnetic anastomosis. Mean time for anastomosis creation was 32 ± 10 minutes. One patient was not implanted because of an inability to bring the ileum to the duodenum. Follow-up rate at 12 months was 95%. A total of 41 procedure-related adverse events were recorded during follow-up. Seven events in 4 subjects were considered serious. Total weight loss at 3, 6, and 12 months was 22 ± 19%, 28 ± 19%, and 31 ± 11%, respectively. Excess weight loss was 45 ± 14%, 59 ± 21%, and 78 ± 33%, respectively. All patients had an hemoglobin A1C ≤6.0% at 12 months with complete T2D remission in 78%.

Conclusion: The SNAP-S procedure is feasible with a low complication rate related to the anastomotic technique itself. The SNAP-S procedure provides significant weight loss and improvement of comorbidities. Additional prospective data are needed to better define the place of SNAP-S procedure.