Patient-specific stomach biomechanics before and after laparoscopic sleeve gastrectomy

Abstract

Background Obesity has become a global epidemic. Bariatric surgery is considered the most effective therapeutic weapon in terms of weight loss and improvement of quality of life and comorbidities. Laparoscopic sleeve gastrectomy (LSG) is one of the most performed procedures worldwide, although patients carry a nonnegligible risk of developing post-operative GERD and BE. Objectives The aim of this work is the development of computational patient-specific models to analyze the changes induced by bariatric surgery, i.e., the volumetric gastric reduction, the mechanical response of the stomach during an inflation process, and the related elongation strain (ES) distribution at different intragastric pressures. Methods Patient-specific pre- and post-surgical models were extracted from Magnetic Resonance Imaging (MRI) scans of patients with morbid obesity submitted to LSG. Twenty-three patients were analyzed, resulting in forty-six 3D-geometries and related computational analyses. Results A significant difference between the mechanical behavior of pre- and post-surgical stomach subjected to the same internal gastric pressure was observed, that can be correlated to a change in the global stomach stiffness and a minor gastric wall tension, resulting in unusual activations of mechanoreceptors following food intake and satiety variation after LSG. Conclusions Computational patient-specific models may contribute to improve the current knowledge about anatomical and physiological changes induced by LSG, aiming at reducing post-operative complications and improving quality of life in the long run.

Artificial sphincters: An overview from existing devices to novel technologies

“…The authors also highlighted how the future use of the methods of bioengineering has the potential to increase the success of surgeries and to improve the performances, in general, of the surgical procedures and, in particular, of currently existing ASs, leading to the development of more reliable and durable devices. [23][24][25] The results of this systematic review were reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Using databasespecific subject headings, SCIENCEDIRECT, PUBMED, GOOGLE SCHOLAR, GOOGLE PATENTS were searched from inception until May 2022.…”

“…Furthermore, an evaluation of well‐established ASs has been conducted by considering the clinical outcomes of several studies, highlighting the response of the biological tissues to the presence and the occluding action of ASs, finding that ASs revisions are due to the failure of the device, or to the establishment of degeneration phenomena in the tissues involved by the device's action. The authors also highlighted how the future use of the methods of bioengineering has the potential to increase the success of surgeries and to improve the performances, in general, of the surgical procedures and, in particular, of currently existing ASs, leading to the development of more reliable and durable devices 23–25 …”

Mechanical experimentation of the gastrointestinal tract: a systematic review

“…reduction in the size of the stomach through a partial gastrectomy) used in the treatment of patients with obesity, on the biomechanics of the GI organs (Toniolo et al. 2022 ), with one aim being to have patient-specific pre- and post-operative computational models of the organ prior to the procedure to provide a means to assess the best surgical intervention and predict potential post-procedural complications. Moreover, surgical simulations are a growing technology which can utilise FE models to provide haptic force feedback information to a surgeon (Chakravarthy et al.…”

Biomechanics of Hollow Organs: Experimental Testing and Computational Modeling

“…Computational models allow the investigation of anatomical districts in both healthy and pathologic conditions, providing information about the biomechanical functionality and the effects of pathologies [11,49,50]. Furthermore, the computational approach entails the possibility of analyzing many different diagnostic and surgical procedures, providing tools for the investigation of the interaction phenomena with devices and prostheses and for the evaluation of post-surgical functionality [8,10,49,51,52].…”