Magnetic compression anastomosis in managing refractory biliary strictures following multiple surgical interventions: a comprehensive review

Abstract

Benign biliary strictures (BBSs), often arising from various etiologies, are frequently linked to surgical complications, particularly after procedures such as living-donor liver transplantation. Although endoscopic and percutaneous approaches are effective for most BBS cases, managing completely obstructed or severely stenotic strictures remains challenging due to the inability to pass a guidewire. Magnetic compression anastomosis (MCA) has emerged as a minimally invasive and non-surgical alternative for treating refractory BBSs. This review comprehensively explores the efficacy and safety of MCA in addressing complex biliary strictures caused by surgical procedures, such as liver transplantation, cholecystectomy, and other hepatobiliary operations. MCA utilizes magnetic force to create a new fistula by inducing necrosis in the strictured tissue. Clinical success rates of up to 87.5 % and low recurrence rates of 7.1 % have been reported. Both experimental and clinical data highlight the feasibility and safety of MCA, particularly in cases involving bilateral biliary or bilioenteric anastomoses. This review discusses the key technical aspects of MCA, such as magnet delivery techniques, optimal magnet size selection, and strategies for complex cases. MCA has a favorable safety profile, with no major adverse events, such as vascular injuries, reported in clinical trials. Long-term follow-up studies suggest that MCA may achieve lower recurrence rates than those with conventional treatments. However, challenges include the lack of reliable pre-procedural assessment tools to predict outcomes and the limited commercial availability of specialized magnets and equipment. Despite these challenges, MCA represents an innovative and effective approach for treating complex biliary strictures, offering a minimally invasive alternative. Further large-scale studies with extended follow-up are required to validate its long-term efficacy and optimize its application in gastroenterology and hepatobiliary medicine.