Toniolo Ilaria, Berardo Alice, Gagner Michel, Foletto Mirto, Carniel Emanuele Luigi
Department of Industrial Engineering, University of Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy.
Centre for Mechanics of Biological Materials, University of Padova, Italy; Department of Civil, Environmental and Architectural Engineering, University of Padova, Italy; Department of Biomedical Sciences, University of Padova, Italy.
Comput Methods Programs Biomed. 2023 Apr;231:107409. doi: 10.1016/j.cmpb.2023.107409. Epub 2023 Feb 9.
Gastro-oesophageal reflux disease (GERD) consists in the passage of gastric acid content from the stomach to the oesophagus, causing burns and deteriorating the quality of life. Laparoscopic Sleeve Gastrectomy (LSG) could induce de novo GERD and worsen pre-existing GERD because of the higher gastric pressurisation, reduction of stomach volume and a wider His-angle. In the proposed work, various computational gastric 2D models were developed to understand the effects of variables such as the His-angle, the antral dimension, and the bolus viscosity on the reflux increase.
Fluid-Structure Interaction (FSI) computational models which couple the solid mechanics of the gastric wall, and the fluid domain of the bolus, have been developed to shed light on biomechanical aspects of GERD after LSG. A closure was imposed to the lower oesophageal sphincter (LES) mimicking what happens physiologically after food intake.
Results showed that the configuration prone to higher reflux flow was the post-surgical 65° model with a staple line starting directly from the pylorus without antral preservation, for all considered viscosities. Increasing viscosity, reflux flow decreased. Post-surgical refluxes were higher than pre-ones and decreased with increasing antrum preservation.
These results could be a starting point for analysis of anatomical features, bariatric surgery and GERD occurrence. Further studies based on 3D geometries need to be performed.
胃食管反流病（GERD）是指胃酸内容物从胃反流至食管，导致灼伤并降低生活质量。腹腔镜袖状胃切除术（LSG）可能会引发新发GERD，并使已有的GERD恶化，原因是胃内压力升高、胃容积减小以及His角增宽。在本研究中，开发了多种二维胃模型，以了解诸如His角、胃窦尺寸和食团粘度等变量对反流增加的影响。
已开发出流体-结构相互作用（FSI）计算模型，该模型将胃壁的固体力学与食团的流体域相结合，以阐明LSG术后GERD的生物力学方面。对食管下括约肌（LES）施加封闭，模拟进食后生理上发生的情况。
结果表明，对于所有考虑的粘度，术后反流流量较高的构型是缝合线直接从幽门开始且不保留胃窦的65°手术模型。粘度增加，反流流量降低。术后反流高于术前，且随着胃窦保留程度的增加而降低。
这些结果可能是分析解剖特征、减肥手术和GERD发生情况的起点。需要基于三维几何形状进行进一步研究。
