Magnet-Assisted Anastomosis in Gastrointestinal Surgery: Current Evidence, Technical Considerations, and Barriers to Clinical Adoption

Gastrointestinal (GI) anastomosis remains a cornerstone of abdominal surgery; however, anastomotic failure continues to represent a significant source of postoperative morbidity, mortality, and healthcare burden despite advances in suturing, stapling, and minimally invasive techniques. Magnet-assisted anastomosis (MAA) has recently re-emerged as an investigational, sutureless technique that utilizes sustained magnetic compression to induce localized ischemia, tissue necrosis, and subsequent biologic fusion of adjacent luminal surfaces without leaving permanent foreign material. Although early reports have demonstrated technical feasibility across select gastrointestinal, bariatric, and pediatric applications, the clinical evidence supporting MAA remains limited, heterogeneous, and largely confined to experimental studies and small clinical series. This qualitative narrative review critically synthesizes the available preclinical and early clinical literature to examine the mechanistic basis of MAA, current technical approaches, early feasibility outcomes, and the practical limitations that currently constrain broader clinical adoption. Particular attention is given to perioperative considerations unique to delayed anastomotic formation, including nutritional management, timing of luminal patency, device-related complications, and postoperative monitoring strategies. While preliminary studies report high technical success rates and successful formation of patent anastomoses in carefully selected patients, the existing literature remains constrained by small sample sizes, heterogeneous study designs, and limited long-term follow-up. Key questions regarding long-term durability, stricture formation, comparative leak risk, and standardized patient selection remain incompletely defined. By synthesizing the fragmented body of evidence on MAA, this review aims to clarify the current state of the field, identify critical knowledge gaps, and outline the research priorities needed to determine whether MAA can play a meaningful role in future gastrointestinal surgical practice.