Abstract
A 19-year-old male, 156 cm tall, weighing 45 kg and with a BMI of 14.3, was diagnosed as having long gap esophageal atresia with a tracheoesophageal fistula (type C) on the day of his birth. On the following day, he underwent surgery comprising fistula ligation plus gastrostomy. Six months later, the patient underwent a definitive delayed primary repair with Livaditis' circular myotomy, but a severe anastomotic stricture of esophagus developed. He underwent endoscopic balloon dilation many times because of the anastomotic stricture, but the effect was limited. The stricture was about 27 cm in the front teeth in endoscopy, and a barium swallow revealed that the length of the stricture was about 2 cm. He was capable of only a small amount of oral ingestion and was fed via the gastrostomy. We judged that a surgical procedure would be difficult due to the decreased respiratory function caused by his tracheomalacia. We therefore treated him with magnetic compression revision anastomosis, in which a pair of 2 cylindrical Samarium-cobalt rare-earth 320 mT (3200 G) magnets, 15×5 mm (diameter×thickness) were used. We inserted endoscopes from the mouth and the gastrocutaneous fistula, and endoscopically placed one magnet orally and the other magnet anally to the stricture, as close together as possible. The magnets bonded together on the third day after the operation, travelled down the digestive tract and were excreted on the 18th day. At a two-year postoperative follow up, the patient was doing well without any sign of restenosis.
