Chiara Giulia Fontanella, PhD, Mirto Foletto, MD, C Salmaso, I Toniolo, Alice Albanese, MD, Pasquale Auricchio, MD, Lino Polese, Professor, Mostafa Altowerqi, MD, Emanuele Luigi Carniel, Professor. University of Padua
Background: Sleeve Gastrectomy (SG) is one of the most performed bariatric procedure worldwide. Unsatisfactory weight loss and de novo gastroesophageal reflux (GERD) are the major long-term concerns, which can be related to the gastric pouch conformation.
Aims: A novel approach is required to better assess SG in the long run. Rational criteria are advocated to provide engineering tools for the forecast of SG efficacy and the identification of the optimal post-surgical stomach configuration.
Methods: The methods of computational and experimental biomechanics allow investigating interactions between bolus and stomach tissues. As bolus interacts with stomach lining, stretching forces develop and their magnitudes increase with food intake. Such mechanical stimuli act on gastric receptors, initiating neural signals, which convey information to the brain. The brain responds by releasing neuro-transmitters that elicit the feeling of satiety, depending on intensity of stomach wall mechanical stimulation.
A computational model of the stomach was developed by means of histo-morphometric investigations and mechanical tests. Computational analyses were performed to evaluate stomach functionality in both pre- and post-surgical conformation, as the stomach pressure-volume behaviour and the mechanical stimulation of gastric receptors.
The stomach computational model was exploited to investigate an endoscopic approach to sleeve gastrectomy. Different clips conformations were investigated, as anchors, spiders, screws and spirals, considering both the endoscopic applicability and the capability to support intraluminal loads.
The results showed the potentiality of computational methods to investigate stomach functionality and to optimize procedures and techniques in bariatric surgery.
Biomechanical approach to stomach functionality. Schematic representation of stomach conformation and regions (a). Virtual solid models of stomach regions and layers with indication of local material directions (b). Model validation by the analysis of stomach inflation behavior: comparison of experimental data and model results (c). Results from computational analyses of stomach functionality: distribution of stretch components along circumferential and longitudinal directions within the muscular layer at 1200 ml inflated volume (a); average values of stretch components in fundus and corpus regions depending on inflated volume (b). Endoscopic approach to bariatric surgery: schematic representation of intraluminal fixation devices (f); clips design for endoscopic fixation, as anchor, spider, screw and spiral; analysis of interaction phenomena between clips and stomach tissues (h).
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95043
Program Number: P059
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster