Published online Jul 28, 2026. doi: 10.3748/wjg.118067
Revised: February 14, 2026
Accepted: April 3, 2026
Published online: July 28, 2026
Processing time: 203 Days and 21.9 Hours
Magnetic compression anastomosis is a third type of anastomosis differing from suture anastomosis and stapled anastomosis. With the development of magnamosis, to meet the usage requirements for different situations, diversified magnetic ring designs are necessary. The deformable self-assembling magnetic anastomosis ring (DSAMAR) is a new combined-type magnetic ring design.
To investigate the anastomosis effects of combined-type and whole-type magnetic rings for gastroenterostomy in a beagle model.
Eighteen beagles were randomly assigned to three groups, in which the DSAMAR, conventional magnetic ring (CMR), and hand-sewn suturing (n = 6 per group, half male and half female) were used for gastroenterostomy. The operation time, survival rate, and incidence of postoperative complications were compared among the three groups. Anastomotic specimens were obtained 1 month after operation, and the gross and histological specimens were analyzed.
The operation times for anastomosis were similar between the DSAMAR group (4.83 ± 1.03 minutes) and CMR group (4.58 ± 0.74 minutes), and both times were lower than that in hand-sewn group (15.25 ± 1.41 minutes). All dogs survived except one in the hand-sewn group that died of a severe abdominal infection caused by anastomotic leakage. The average times to magnetic ring release were 9.83 ± 2.64 days in the DSAMAR group and 10.50 ± 2.88 days in the CMR group. In gross specimens, the anastomotic stomas of the DSAMAR group and CMR group were significantly smoother than those of the hand-sewn group, and residual sutures were observed in the hand-sewn group. Histological analysis showed that the mucosa of anastomosis was smooth in both magnetic anas
Gastroenterostomy was achievable using the DSAMAR in a beagle model. The combined-type magnetic rings can achieve the same anastomosis effect as whole-type magnetic rings for gastrointestinal anastomosis.
Core Tip: We designed a deformable self-assembling magnetic anastomosis ring (DSAMAR) that can pass through a severely narrow digestive tract, to facilitate magnetic compression anastomosis reconstruction of the digestive tract under endoscopy. We set up two control groups, the common magnetic ring group and the manual suture group, to analyze the anastomotic effect of gastric bypass anastomosis with the DSAMAR. The results showed that the anastomosis effect achieved with the DSAMAR was similar to that in the common magnetic ring group and better than that in the hand-sewn group. This study lays a solid foundation for further clinical application of the DSAMAR.
- Citation: Zhang MM, Xu SQ, Wu HX, Ren HL, Wan JH, Zhong QY, Chen MY, Zhang QF, Gong RM, Yusif-Zada K, Badarch BI, Shi AH, Lyu Y, Liu XM, Yan XP. Comparison of the anastomotic effects of combined-type and whole-type magnetic rings for gastrointestinal anastomosis in beagles. World J Gastroenterol 2026; 32(28): 118067
- URL: https://www.wjgnet.com/1007-9327/full/v32/i28/118067.htm
- DOI: https://dx.doi.org/10.3748/wjg.118067
In the 40 years since the Japanese scholars Obora et al[1] first reported the concept of magnetic compression anastomosis in 1978, research on magnetic compression anastomosis has become increasingly extensive. In the field of vascular magnetic compression anastomosis, its technical applications have advanced from end-to-end anastomosis and side-to-side anastomosis under open surgery to interventional vascular anastomosis reconstruction[2-5]. With the development of magnetic compression anastomosis, gastrointestinal anastomosis has become an important application site for magnetic anastomosis technology. Several studies have reported the use of magnetic anastomosis within the digestive tract from the esophagus to the colon[6-10], and some of these techniques have been applied in clinical practice and achieved good results[11-13]. With the continuous development and improvement of digestive endoscopic technology, the combination of magnetic anastomosis and digestive endoscopic technology has made endoscopic operations possible for some surgeries related to the digestive system. Endoscopic magnetic compression anastomosis is associated with greater requirements for magnet design. Easy placement, good controllability and excellent anastomosis are the most basic requirements for endoscopic anastomosis magnets.
To meet the requirements for endoscopic operation, Ryou et al[14] designed the Smart Self-Assembling MagnetS for Endoscopy, which represents the earliest deformable magnetic ring design concept. With further improvement and optimization, the self-forming magnet anastomosis system has been used for endoscopic jejunal anastomosis[15]. However, the self-forming magnet is only suitable for digestive tract anastomosis in cases with a normal anatomical structure and cannot be used in cases of severe stenosis of the digestive tract.
To overcome this limitation, we designed a deformable self-assembling magnetic anastomosis ring (DSAMAR) that can pass through a severely narrow digestive tract. The magnetic anastomosis ring self-assembles from 10 small trapezoidal magnet elements, and its working surface is composed of 10 independent but closely related trapezoidal elements, which is different from previous magnet structure designs. In the present study, we evaluated the feasibility of the DSAMAR for gastrointestinal anastomosis in comparison with a conventional magnetic ring (CMR) and manual suture anastomosis as controls.
The experimental protocol was approved by the Experimental Ethics Committee of Xi’an Jiaotong University, No. 2022-1451. Eighteen beagle dogs (male, n = 9 and female, n = 9) were obtained from the Laboratory Animal Center of the Xi’an Jiaotong University (Xi’an, China). This study is reported in accordance with ARRIVE guidelines. The research protocol and all the experimental procedures were strictly in accordance with the Guidelines for the Care and Use of Experimental Animals issued by the Xi’an Jiaotong University Medical Center.
Eighteen beagle dogs weighting 12-15 kg were randomly divided into three groups according to the approach used for gastroenterostomy: The DSAMAR group (n = 6), the CMR group (n = 6), and the hand-sewn group (n = 6). Each group was half male and half female. Anastomosis specimens were obtained 1 month after operation and analyzed by visual inspection and pathology to compare the anastomosis effects achieved with the different approaches.
The DSAMAR consists of 10 small trapezoidal magnetic units. Each trapezoidal magnetic unit has a small hole in the center of the side that allows a hard guide wire to pass through. Under the constraint of the hard guide wire, the 10 trapezoidal magnetic elements can be arranged into a straight line. When the guide wire is withdrawn, the adjacent magnetic elements will attract each other at their sides. After the self-assembly and deformation process, a magnetic ring with an inner diameter of 13 mm, an outer diameter of 25 mm, and a thickness of 5 mm will be formed (Figure 1A). The mass of the formed magnetic ring is 12.53 g. The CMR used in the study was an ordinary magnetic ring with an inner diameter of 13 mm, an outer diameter of 25 mm, and a thickness of 5 mm (Figure 1B). The mass of the CMR was 12.28 g.
The magnetic properties of DSAMAR and CMR were tested using an electronic universal testing machine (UTM6202, Shenzhen Suns Technology Stock, Shenzhen, China). The magnetic force test showed the magnetic force-displacement curves of the two types of magnets (Figure 2). The magnetic forces of DSAMAR and CMR were 184.57 N and 40.94 N, respectively, when the displacement was zero. The magnetic flux density can be calculated by computer simulations (Figure 3).
The beagles were fasted from solids for 12 hours and liquids for 6 hours before surgery. They were anesthetized by intravenous injection of 3% pentobarbital sodium (1 mL/kg) and fixed in the supine position. An incision about 20 cm in length along the middle of the upper abdomen was made into the abdominal cavity. The stomach and duodenum were separated and determined.
For the DSAMAR group, an incision approximately 2.5 cm in length was made on the anterior wall of the stomach where few blood vessels were located in the greater curvature of the stomach. A DSAMAR was placed through the incision in the anterior wall of the stomach (Figure 4A) and pushed to the end of the duodenum. Then another DSAMAR was placed in the stomach. The magnetic ring suction surface was adjusted to the gastric posterior wall and the opposite mesenteric edge of the duodenal intestine, and the two magnetic rings were slowly pulled close to each other for automatic attraction (Figure 4B). Finally, 3-0 silk thread was used to close the incision in the front wall of the stomach. The operation procedure for CMR placement was similar to that for the DSAMAR group except CMRs were used (Figure 4C and D). For the hand-sewn group, incision approximately 2.5 cm in length were made at the same positions as in the other two groups, that is, on the posterior wall of the stomach and the end of the duodenum. Gastroenterostomy was then performed using two layers of interrupted sutures (Figure 4E and F).
After the operation, X-ray examination was performed for the DSAMAR and CMR groups to confirm the magnet attraction status. X-ray examination was then performed every day to observe any changes in the position and status of the magnets until the magnets were expelled. For post-operative analgesia, pethidine hydrochloride (1 mg/kg) was injected intramuscularly every 12 hours for 2 days. For post-operative infection control, cefotiam (0.5 g) was given intravenously every 12 hours for 3 days. The beagles were fed a liquid diet for the first 3 days after the operation, and then a normal diet was gradually restored.
One month after the operation, the animals in all three groups were euthanized [intravenous injection of pentobarbital sodium (60 mg/kg)] for harvesting of the stomach and duodenum. The gross specimens of anastomosis were observed by the naked eye. The duodenal stump of the anastomotic specimen was clamped with a vascular clamp, and a catheter was inserted into the esophageal stump and ligated with silk thread. The whole anastomotic specimen was then immersed in 0.9% normal saline solution for measurement of the bursting pressure of the anastomosis with a pressure gauge. As the pressure in the cavity gradually increased, the point where the first bubble rose to the liquid surface was recorded as the bursting pressure.
The circumference of each anastomotic specimen was measured and recorded. The anastomotic specimen was then soaked overnight in 10% formalin. After fixation, the specimen was embedded in paraffin, and 4-μm-thick sections were prepared for histological evaluation. The sections were stained with hematoxylin and eosin and Masson’s trichrome stain and then examined under a bright-field microscope.
The anastomosis operation time for each group and the magnet shedding time for the DSAMAR and CMR groups were recorded. The anastomosis operation time for the two magnamosis groups was defined as the time required to insert the magnets on the stomach and duodenum sides and induce their attraction, while the anastomosis operation time for the hand-sewn group was defined as the time to apply two layers of interrupted sutures in the incisions on the stomach and duodenum sides. The bursting pressure and circumference of anastomosis were recorded for each specimen.
SPSS statistical 20.0 software was used for data analysis. Quantitative data that followed a normal distribution are described with mean ± SD values, while quantitative data with a non-normal distribution are described with median values. Differences between groups were analyzed by independent sample t-test or nonparametric test. P < 0.05 indicated a significant difference.
Gastroenterostomy was successfully performed in all beagle dogs of the three groups. The anastomosis operation time did not differ significantly between the DSAMAR group (4.83 ± 1.03 minutes) and CMR group (4.58 ± 0.74 minutes, P = 0.64), whereas the anastomosis time in the hand-sewn group was significantly longer than the time of the other two groups (15.25 ± 1.41 minutes; DSAMAR group vs hand-sewn group, P < 0.001; CMR group vs hand-sewn group, P < 0.001). After anastomosis, X-ray examination confirmed that magnet positioning and attraction state were appropriate in both the DSAMAR and CMR groups (Figure 5).
The survival rates of animals in both the DSAMAR and CMR groups were 100%. In the hand-sewn group, one dog died due to anastomotic leakage. No bleeding, anastomotic leakage, perforation, anastomotic stenosis, or other postoperative complications occurred in any other dogs. The time to magnet release in the DSAMAR group was 9.83 ± 2.64 days, and that in the CMR group was 10.50 ± 2.88 days, with no statistically significant difference observed between the groups (P = 0.69).
Gross specimens were obtained after 1 month from all animals. For all specimens, the burst pressure of the anastomosis was greater than 300 mmHg. The measured anastomosis circumference did not differ significantly between the DSAMAR group (63.68 ± 3.99 mm) and the other two groups (64.07 ± 4.27 mm, DSAMAR group vs CMR group, P = 0.88; 65.04 ± 3.51 mm, DSAMAR group vs hand-sewn group, P = 0.57). Gross specimens showed that the serosal and mucosal surfaces of anastomosis in the DSAMAR and CMR groups were smooth and continuous. However, silk residue was observed on the serosal and mucosal surfaces of the anastomosis in the hand-sewn group, and the smoothness of the anastomosis was not as good as that in the two magnamosis groups (Figure 6). The results for the three experimental groups are shown in Table 1. Hematoxylin and eosin and Masson’s trichrome staining of all specimens showed that all layers of the anastomosis healed well, and in the DSAMAR and CMR groups, the mucosal layer was smooth and flat. In contrast, disordered fiber arrangement was observed in specimens of the hand-sewn group (Figure 7).
| Group | n | Operation time, minutes | The time to magnets release, days | The burst pressure of anastomosis, mmHg | Circumference of the anastomosis, mm |
| DSAMAR group | 1 | 5 | 9 | > 300 | 65.2 |
| 2 | 4.5 | 7 | > 300 | 59.5 | |
| 3 | 6 | 12 | > 300 | 69.0 | |
| 4 | 3 | 14 | > 300 | 58.8 | |
| 5 | 5.5 | 8 | > 300 | 63.2 | |
| 6 | 5 | 9 | > 300 | 66.4 | |
| CMR group | 7 | 4.5 | 7 | > 300 | 58.4 |
| 8 | 5 | 11 | > 300 | 62.5 | |
| 9 | 3.5 | 15 | > 300 | 71.3 | |
| 10 | 5 | 10 | > 300 | 65.0 | |
| 11 | 5.5 | 12 | > 300 | 62.4 | |
| 12 | 4 | 8 | > 300 | 64.8 | |
| Hand-sewn group | 13 | 15 | NA | > 300 | 68.4 |
| 14 | 13 | NA | > 300 | 64.5 | |
| 15 | 16 | NA | NA1 | NA1 | |
| 16 | 14.5 | NA | > 300 | 67.4 | |
| 17 | 17 | NA | > 300 | 65.5 | |
| 18 | 16 | NA | > 300 | 59.4 |
Magnetic compression anastomosis in the digestive tract is the most in-depth and widely used application of magnetosurgery at present. With research advances in magnetic compression anastomosis in the digestive tract, a series of key concepts in magnetic surgery, such as “magnetic compression anastomosis” and “magnamosis” have been successively introduced[16,17]. In terms of theoretical innovation, Zhang et al[18] reported staging of magnetic compression anastomosis in the digestive tract. In terms of technical innovation, laparoscopic magnetic compression anastomosis and the combination of magnetic compression anastomosis and endoscopic techniques have greatly advanced the clinical application of magnamosis[19,20].
In previous reports of magnetic compression anastomosis in the digestive tract, most of the magnetic anastomosis rings used were whole cylinders or rings[6,7,9,10,13,19]. This design offers the maximum structural stability of magnets but also limits their flexibility during placement. The DSAMAR introduced in the present study is composed of 10 trapezoidal magnets, which are placed in a straight line and then self-assemble to form a ring. An important advantage of the DSAMAR is that it can pass through a severely narrow digestive tract, thereby creating conditions for endoscopic gastrointestinal anastomosis. However, because the DSAMAR is a non-monolithic structure, it is necessary to evaluate experimentally whether the magnetic ring will be deformed and how the anastomosis will form after the magnets are placed in the body.
The main objective of this study was to evaluate the safety and quality of the anastomosis achieved with the use of the DSAMAR for gastroenterostomy, and techniques for implementing the DSAMAR under endoscopy will be introduced in further studies. The results of the present study showed that the DSAMAR did not exhibit magnetic ring deformation after implantation in the animals. Additionally, no significant differences in the operative time for anastomosis or magnetic ring released were observed for the DSAMAR in comparison with a CMR. Gross observation of the anastomosis specimens showed that the two types of magnetic rings established good anastomosis, and the mucosa of the anastomosis was smooth, which was significantly better than that of the manual suture anastomosis group. The bursting pressure did not differ between the three groups, and histopathological observation showed that all layers of anastomosis tissue in the magnetic anastomosis groups and the manual suture anastomosis group healed well.
This study demonstrates that the DSAMAR can achieve reliable and stable gastrointestinal anastomosis, which provides a crucial basis for further research and clinical application. The relatively small sample size of the experimental group is the limitation of this study. In future studies, the use of experimental pigs, which are more similar to humans, as model animals and the inclusion of a larger sample size will help to better evaluate the anastomosis effect of the DSAMAR. Furthermore, to fully evaluate the deformability of the DSAMAR, more meaningful and valuable results can be obtained by completing gastrointestinal anastomosis under total endoscopic control.
Because the DSAMAR is composed of 10 trapezoidal magnetic units, its stability is weaker than that of a magnet with a single block structure. In our preliminary experiments, we found that when the DSAMAR is close to a larger magnet, under interference from an external magnetic field, the already self-assembled ring structure of the DSAMAR will change, with each magnetic unit arranged in a disorderly manner. Therefore, when applying the DSAMAR for anastomosis, a strong magnetic field environment should be avoided, because a high external magnetic field can disrupt the alignment of the individual magnets, possibly causing failure.
In the present study, the quality of anastomosis achieved in the three groups was evaluated by gross observation, histological observation, and bursting pressure measurement of anastomotic specimens. The effectiveness of the DSAMAR for gastrointestinal anastomosis will enhance various magnetic options for surgery. A limitation of this study was the lack of quantitative analysis of inflammatory cell infiltration and collagen content in the anastomotic tissues of the three groups. In addition, results from a longer period of anastomotic observation, such as 3-6 months, may provide more convincing evidence of the effectiveness of the introduced approach. In this study, scientific determination of the sample size for each group was challenging, and thus, it is unknown whether six experimental dogs per group is appropriate. Perhaps a larger sample size could provide more reliable conclusions.
The results of this study demonstrate that DSAMAR placement is feasible in gastroenterostomy and can achieve the same anastomosis effect as the conventional magnetic anastomosis ring. A significant finding of this study is that despite some differences in the magnetic field distribution between the self-assembled magnetic ring and the conventional whole magnetic ring, no difference in the anastomosis effect was detected, which lays a solid foundation for further clinical application of the DSAMAR.
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