Available online 4 January 2024, 151381

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Since the 1970s, magnets have been progressively harnessed for use in minimally invasive treatment of pediatric surgical disease. In particular, multiple magnetic devices have been developed for treating esophageal atresia, pectus excavatum and scoliosis. These devices, which can be placed via small incisions or under endoscopic or fluoroscopic guidance, provide the added benefit of sparing patients multiple large, invasive procedures, and allowing for gradual correction of congenital anomalies over days to months, depending on the disease. In the following text, we detail the current landscape of magnetic devices used by pediatric surgeons, illustrate their use through clinical cases, and review the available body of literature with respect their outcomes and complications.

Section snippetsINTRODUCTION

The first clinical application of magnets in pediatric surgery was introduced by Drs. Hendren and Hale in 1975, who applied electromagnetic bougienage to lengthen esophageal segments in a patient with congenital esophageal atresia (EA).1 Following this initial innovation, magnetic devices have been employed across a wide array of clinical indications with a myriad of uses. Today, magnets are used clinically as guidance systems, compression anastomosis devices, artificial physiologic sphincters,

Esophageal Atresia

The FlourishTM Pediatric Esophageal Atresia Device (Cook Medical, Bloomington, IN) was the first catheter-based magnetic device approved by the United States Food and Drug Administration (FDA) for treatment of EA via a Humanitarian Use Exemption. It is indicated for use in lengthening atretic esophageal ends and creating an anastomosis in infants up to one year of age with atresia segments less than four centimeters apart (Fig. 1).7 The device received humanitarian exemption approval in 2021

Magnets in Primary Anastomosis for Esophageal Atresia

Slater et al. reported the largest published series of 13 patients with esophageal atresia who underwent placement of a magnetic anastomosis using the FlourishTM Pediatric Esophageal Atresia Device (Cook Medical, Bloomington, IN).22 A total of 85% of the patients had type A esophageal atresia and 15% of the patients had a type C EA with previous ligation of the fistula. The distances between the esophageal ends were <4 cm. The age of patients in the series averaged 4.5 months (2–7.5 months),

Esophageal Atresia

At present, a prospective single-arm observational study is ongoing evaluating the safety and efficacy of the FlourishTM Pediatric Esophageal Atresia Device. Published experience to date concerning the use of magnets in EA generally has been characterized by small cohorts with a high rate of stricture formation after magnet therapy.3,4,9,22,23 In these studies, the average number of days to anastomosis ranged from 4.2 to 13 and postoperative outcomes were notable for a rate of stricture

MAGNETS IN PEDIATRIC SURGERY: THE FUTURE

As technology advances and allows pediatric surgeons to perform increasingly minimally invasive surgery, magnets will become a progressively more powerful tool for treating pediatric diseases. Currently, magnet technology has shown significant benefits in obviating invasive surgical procedures in high-risk patients, as well as decreasing the number of invasive procedures necessary for correcting congenital growth anomalies. Though magnet-based surgical devices are still early in their

ENDORSEMENT

A talented group of Surgeons has put together a wonderful and handy compendium of the past and future uses of magnets in surgery. This is particularly useful for Pediatric Surgeons who treat most of the potential patients ie esoghageal atresia, pectus excavatum, and scoliosis. Surgical use of magnetic force to alter organ and tissue growth and development has come of age.

Michael Harrison

San Francisco

References (26)BA Akbarnia et al.Next generation of growth-sparing techniques: preliminary clinical results of a magnetically controlled growing rod in 14 patients with early-onset scoliosis

Spine (Phila Pa 1976)

(2013)

Min L, Connell J. FlourishTM Pediatric Esophageal Atresia Device: H150003. In: Team GaED, Division of Renal G, Obesity...R Woo et al.Magnetic Compression Stricturoplasty For Treatment of Refractory Esophageal Strictures in Children: Technique and Lessons Learned

Surg Innov

(2017)

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