Post written by iGIE iNTERNATIONAL Associate Editor Diogo Turiani Hourneaux de Moura, MD, MSc, PhD, from the Gastrointestinal Endoscopy Division, Hospital Vila Nova Star, Instituto D’Or de Pesquisa e Ensino, and the Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

The goal of this study was to demonstrate different approaches for the treatment of refractory anastomotic leaks and focus on the importance of endoscopic internal drainage therapies.

It was important to conduct this study to examine the novel use of magnets for internal drainage by an anastomosis between the collection and the GI lumen.

Postsurgical leaks are a dreaded adverse event of colorectal surgery. Although surgical management and endoscopic traditional therapies are often successful, alternative therapies are necessary when both approaches fail.

This article is the first case report of the use of magnetic anastomosis to provide internal drainage. We report the case of a 60-year-old man who underwent surgical treatment of a rectal adenocarcinoma and presented with a dehiscence of the suture line with an associated contained collection. He underwent 2 surgical revisions and several conventional endoscopic therapies to treat this adverse event with no successful closure.

Thus, endoscopic internal drainage with magnetic anastomosis followed by septotomy and endoscopic vacuum therapy for 1 week were successfully performed. At 6-month follow-up, rectoscopy showed a normal rectal/colonic tubular shape without signs of transmural defects and stenosis.

It is well-known that endoscopic internal drainage is a safe and effective strategy for managing leaks associated with contained collections. When conventional techniques fail, the use of magnets for internal drainage by an anastomosis between the collection and the lumen appears to be an attractive option.

This approach has the potential to enhance patient outcomes, improve quality of life, and reduce morbidity. Further research is required to validate our findings.

Illustration of the magnet anastomosis process. A, Colorectal anastomosis leak associated with a contained collection. B, Magnet placement, 1 within the proximal portion of the contained collection and 1 inside the colonic lumen. C, Strong connection between the 2 magnets. D, Because the associated collection was located parallel to the colon, attachment of the 2 magnets occurred. E, The strong connection between the 2 magnets promoted tissue ischemia, and the interconnected magnets migrated into the colon. F, An anastomosis connected the contained collection with the colonic lumen with a septum (colonic wall) between the colorectal and the magnet anastomosis. G, A guidewire was placed around the septum to enable septotomy. H, An electrocautery knife was used to perform septotomy. I, The septotomy created a complete communication of the associated contained cavity with the colorectal lumen. J, This approach turned the 2 compartments into 1, creating a neorectum.

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