Background

Historically, bariatric anastomoses have been made with sutures and/or metal staples, but have caused significant bleeding and leaks. This video demonstrates compression anastomosis using linear endoluminal magnets to achieve weight loss and remission of co-morbidities. A 43 y.o. female patient who previously had a laparoscopic sleeve gastrectomy in December 2019 (370 lbs and BMI= 61.6 kg/m2) had Tobacco usage, Joint pains, Depression, Proximal Gastric Polyps, and Non-Alcoholic Fatty Disease. After more than 18 months, the BMI was 43.3 kg/m2 with Depression-Anxiety, mild GERD, Joint pains, and Secondary Hyperparathyroidism. Hence, a revisional bariatric procedure, a second-stage Laparoscopic/Endoscopic MAGNETIC Side-to-Side Duodeno-Ileostomy (MAGDI) was proposed. This is different from SADI, where the anastomosis is end-to-side. MAGDI permits full duodenal access to the ampulla, absorption of minerals and vitamins B+C complex, and is fully reversible with simple stapling. A linear magnet was delivered by flexible endoscopic catheter to a point 250 cm proximal to the ileocecal valve, and a second magnet was positioned in the first part of the duodenum; the bowel segments containing the magnets were apposed to initiate gradual incision-less compression. Laparoscopic assistance was used to obtain accurate bowel measurements, obviate tissue interposition, and close mesenteric defects. Initial human data have shown that the creation of a side-to-side magnetic compression anastomosis to achieve duodeno-ileostomy diversion in adults with severe obesity appeared to be safe, achieved weight loss, and ameliorated T2D in the short term.