Four-Year Outcomes of Duodeno-Ileal Bipartition Using Self-Forming Magnets: The Sutureless Neodymium Anastomosis Procedure (SNAP) for Obesity and Type 2 Diabetes

Abstract Background Single-anastomosis duodenal-ileal bypass and duodeno-ileal bipartition are effective metabolic surgeries but remain technically demanding due to the complexity and risk of duodeno-ileal anastomotic leaks.. Magnetic compression anastomosis using Self-Forming Magnets (SFM) offers a simplified, sutureless alternative that may reduce procedural risk. This study evaluated the feasibility, safety, and four-year outcomes of the SFM Sutureless Neodymium Anastomosis Procedure (SNAP) in patients with obesity and type 2 diabetes mellitus (T2DM). Methods This prospective, single-center study included patients with obesity and T2DM. The SNAP technique involved endoscopic and laparoscopic deployment of SFMs to create a duodeno-ileal anastomosis without sutures or staples. Primary endpoint was change in hemoglobin A1c (HbA1c) through 48 months. Secondary endpoints included percent total weight loss (%TWL) and safety outcomes. Results Fourteen patients (age 48 ± 9 years; 50% female; baseline BMI 40.4 ± 3.7 kg/m²) underwent successful SNAP creation (technical success 100%). Mean procedural time was 68 ± 20 minutes. No adverse events occurred. HbA1c significantly decreased from 8.3 ± 1.3% to 6.4 ± 0.6%, 6.6 ± 1.2%, 6.4 ± 1.5%, and 6.9 ± 1.8% at 12, 24, 36, and 48 months, respectively (all p < 0.05). Corresponding %TWL was 13.4 ± 8.6%, 14.2 ± 11.5%, 15.6 ± 13.6%, and 13.5 ± 12.9%. Conclusions SFM-assisted duodeno-ileal bipartition using the SNAP technique is feasible, safe, and durable, producing clinically meaningful and sustained weight loss and glycemic improvement over four years. This magnet-based, sutureless approach may represent a less invasive alternative to conventional duodeno-ileal anastomosis in metabolic surgery.