Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, chemin des Bourrely, 13915 cedex 20, Marseille, France.
Laboratory of Applied Biomechanics UMRT24, Aix-Marseille University / IFSTTAR, Marseille, France.
Obes Surg. 2019 Sep;29(9):2773-2780. doi: 10.1007/s11695-019-03924-2.
A gastric leak (GL) represents the main post-operative complication following a sleeve gastrectomy (SG) and occurs most commonly at the top of the stapling, without any clear explanation.
This experimental study evaluates the biomechanical behavior of post-SG gastric specimens using both insufflation and tensile tests.
A total gastrectomy followed by an ex vivo SG was performed in 15 pigs. The "sleeved" stomachs were subjected to intraluminal hyperpressure until failure. Uniaxial circumferential and longitudinal tensile tests were performed using gastric strips obtained from the "resected" stomachs. All the deformations and burst pressures were recorded and analyzed.
A GL appeared in the upper third of the stapling in 73% of cases. The mean burst pressure was 26.3 ± 5.3 mmHg and was significantly correlated with the volume of the "sleeved" stomachs (p = 0.02). The overall deformation of the "sleeved" stomachs was comparable in the frontal (38.3%) and profile (40.5%) planes. The greatest displacement was observed at the failure zone (11 mm on average). The biomechanical behavior of the stomach wall differed according to the strip orientation. The circumferential strips presented a higher strain-to-failure rate (97%) and a lower Young's modulus (0.99 MPa) when compared to the longitudinal strips (45% and 2.58 MPa, respectively).
This preliminary study reproduced a GL in the same location as observed during clinical practice. The volume of the SG influenced the burst pressure. Further experimental studies and numerical simulations should evaluate the impact of shape modifications on an SG.
胃漏（GL）是袖状胃切除术（SG）后主要的术后并发症，最常发生在吻合口的顶部，但其发生原因目前尚不清楚。
本实验研究通过充气和拉伸试验评估 SG 后胃标本的生物力学行为。
在 15 头猪中进行全胃切除术和体外 SG。将“袖套”胃内充气至压力过高，直至胃破裂。使用取自“切除”胃的胃条进行单轴环向和纵向拉伸试验。记录和分析所有变形和破裂压力。
在 73%的病例中，GL 出现在吻合口的上三分之一处。平均破裂压力为 26.3±5.3mmHg，与“袖套”胃的体积显著相关（p=0.02）。“袖套”胃的整体变形在正面（38.3%）和侧面（40.5%）平面相似。最大位移发生在失效区域（平均 11mm）。胃壁的生物力学行为根据条带方向而不同。环向条带的失效应变率（97%）和杨氏模量（0.99MPa）均高于纵向条带（分别为 45%和 2.58MPa）。
本初步研究在与临床实践中观察到的相同位置再现了 GL。SG 的体积影响破裂压力。进一步的实验研究和数值模拟应评估形状修改对 SG 的影响。
