Background

This video demonstrates compression anastomosis using linear magnets to achieve weight loss and remission of co-morbidities, and used as a revision strategy for weight regain after sleeve gastrectomy. Options may vary and may include Single Anastomosis Duodeno-Ileostomy (SADI), but recently side-to-side magnetic duodeno-ileostomy (MAGDI) has been described as an interim step, causing less malnutrition and provides access to the duodenum (duodenal bipartition). Another version of these bipartitions is the SASI or so called Single Anastomosis Sleeve-Ileostomy.Several steps are shown in a recent laparoscopic Magnetic Gastro-Ileostomy (MAGGI). A new longer linear magnet was delivered by gastroscopy using a flexible endoscopic catheter in the duodenum under sedation, and after 3 hours, radiological confirmation was obtained to establish a jejunum position (from peristalsis). At laparoscopy, a positioning device transported the endoluminal jejunal magnet to a point 250 cm proximal to the ileocecal valve. Posterior gastric adhesions were cleared in order to support a posterior anastomosis, behind old metal clips and previous stapled line. A second linear magnet was positioned by gastroscopy in the gastric antrum; the segments containing the magnets were apposed to initiate gradual incisionless compression. No enterotomies were necessary and avoided. Laparoscopic assistance was used to obtain accurate bowel measurements, divide adhesions, avoid tissue interposition, and close mesenteric defects. MAGGI can be used as a bipartition, bringing the ileal loop with the gastric antrum, it also permits duodenal access in case of biliary pathologies, and can be reversed with linear stapling if necessary.