Department of Industrial Engineering, University of Padova, Padova, Italy.
Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy.
Surg Endosc. 2022 Nov;36(11):7998-8011. doi: 10.1007/s00464-022-09233-7. Epub 2022 Apr 22.
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.
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.
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.
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.
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.
肥胖已成为全球性的流行病。减重手术被认为是减轻体重、改善生活质量和合并症最有效的治疗手段。腹腔镜袖状胃切除术（LSG）是目前全球应用最广泛的手术之一，但患者术后发生胃食管反流病（GERD）和 Barrett 食管（BE）的风险不可忽视。
本研究旨在开发计算患者特异性模型，以分析减重手术引起的变化，即胃容量减少、胃在充气过程中的力学响应以及不同胃内压下相关的伸长应变（ES）分布。
从接受 LSG 的病态肥胖患者的磁共振成像（MRI）扫描中提取患者特异性术前和术后模型。共分析了 23 例患者，得到 46 个 3D 几何模型和相关的计算分析。
观察到术前和术后胃在相同胃内压下的力学行为存在显著差异，这与胃整体刚度和胃壁张力的变化有关，导致 LSG 后进食和饱腹感变化时机械感受器的异常激活。
计算患者特异性模型可能有助于提高对 LSG 引起的解剖和生理变化的现有认识，从而降低术后并发症的发生率，并从长远来看提高生活质量。
