Computational Tools for the Reliability Assessment and the Engineering Design of Procedures and Devices in Bariatric Surgery

Salmaso, C.; Toniolo, Ilaria; Fontanella, Chiara Giulia; Roit, Pietro Da; Albanese, Alessio; Polese, Lino; Stefanini, Cesare; Foletto, Mirto; Carniel, Emanuele Luigi

doi:10.1007/s10439-020-02542-9

Cited by 11 publications

(14 citation statements)

References 46 publications

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“…In addition, the computational approach can be extended to indagate other well-established bariatric procedures or new and innovative methods, as reported in other studies The values were calculated at different intragastric pressure conditions, as 7.5 mmHg, 15 mmHg, 22.5 mmHg and 37.5 mmHg 1 3 [21,38]. The main limitation includes the use of a simplified geometry (hollow cylinders), and digestion and absorption phenomena, effect of gastric motility and interaction between the food bolus and gastric wall were not considered yet.…”

Section: Discussionmentioning

confidence: 99%

Computational evaluation of laparoscopic sleeve gastrectomy

et al. 2021

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LSG is one of the most performed bariatric procedures worldwide. It is a safe and effective operation with a low complication rate. Unsatisfactory weight loss/regain may occur, suggesting that the operation design could be improved. A bioengineering approach might significantly help in avoiding the most common complications. Computational models of the sleeved stomach after LSG were developed according to bougie size (range 27–54 Fr). The endoluminal pressure and the basal volume were computed at different intragastric pressures. At an inner pressure of 22.5 mmHg, the basal volume of the 54 Fr configuration was approximately 6 times greater than that of the 27 Fr configuration (57.92 ml vs 9.70 ml). Moreover, the elongation distribution of the gastric wall was assessed to quantify the effect on mechanoreceptors impacting satiety by differencing regions and layers. An increasing trend in elongation strain with increasing bougie size was observed in all cases. The most stressed region and layer were the antrum (approximately 25% higher stress than that in the corpus at 37.5 mmHg) and mucosa layer (approximately 7% higher stress than that in the muscularis layer at 22.5 mmHg), respectively. In addition, the pressure–volume behaviors were reported. Computational models and bioengineering methods can help to quantitatively identify some critical aspects of the “design” of bariatric operations to plan interventions, and predict and increase the success rate. Moreover, computational tools can support the development of innovative bariatric procedures, potentially skipping invasive approaches.

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Section: Discussionmentioning

confidence: 99%

Computational evaluation of laparoscopic sleeve gastrectomy

et al. 2021

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“…The methods of biomechanics may provide useful tools for the rational comprehension of BS [ 29 , 40 ]. To emphasize the potential of the computational approach, a stomach biomechanical model was developed and utilized to analyze postsurgical configurations and to compare different bariatric techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Preliminarily, the analysis of tensile tests on tissue specimens by Zhao et al [ 39 ] led to sets of constitutive parameters for connective stratum and muscularis externa of fundus, corpus, and antrum regions. Subsequently, the computational model of the stomach was exploited to simulate mechanical tests at the structure level, such as inflation tests [ 29 , 33 , 34 , 40 ]. Constitutive parameters were updated to the agreement between model results and median experimental data, providing a reliability assessment of the developed computational framework.…”

Section: Methodsmentioning

confidence: 99%

“…In this sense, the evaluation of mechanical stimulation of the gastric wall is fundamental for the comprehension of the effects of bariatric intervention on the mechanisms of satiety and satiation [ 28 ]. It follows that the methods of computational biomechanics allow an engineering contribution to BS intervention design that is aimed at providing valid support to surgeons in the presurgical decision-making process and success rate prediction, thus raising the success rate of surgical procedures and devices [ 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical Investigation of the Stomach Following Different Bariatric Surgery Approaches

et al. 2020

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Background: The stomach is a hollow organ of the gastrointestinal tract, on which bariatric surgery (BS) is performed for the treatment of obesity. Even though BS is the most effective treatment for severe obesity, drawbacks and complications are still present because the intervention design is largely based on the surgeon’s expertise and intraoperative decisions. Bioengineering methods can be exploited to develop computational tools for more rational presurgical design and planning of the intervention. Methods: A computational mechanical model of the stomach was developed, considering the actual complexity of the biological structure, as the nonhomogeneous and multilayered configuration of the gastric wall. Mechanical behavior was characterized by means of an anisotropic visco-hyperelastic constitutive formulation of fiber-reinforced conformation, nonlinear elastic response, and time-dependent behavior, which assume the typical features of gastric wall mechanics. Model applications allowed for an analysis of the influence of BS techniques on stomach mechanical functionality through different computational analyses. Results: Computational results showed that laparoscopic sleeve gastrectomy and endoscopic sleeve gastroplasty drastically alter stomach capacity and stiffness, while laparoscopic adjustable gastric banding modestly affects stomach stiffness and capacity. Moreover, the mean elongation strain values, which are correlated to the mechanical stimulation of gastric receptors, were elevated in laparoscopic adjustable gastric banding compared to other procedures. Conclusions: The investigation of stomach mechanical response through computational models provides information on different topics such as stomach capacity and stiffness and the mechanical stimulation of gastric receptors, which interact with the brain to control satiety. These data can provide reliable support to surgeons in the presurgical decision-making process.

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“…Referring to the digestive tract, few work articles focused on the 3D geometry of the esophagus and stomach starting from medical imaging to simulate the surgical procedure in order to improve the outcomes [ 33 , 34 ]. Moreover, the stomach was previously studied with finite elements approaches, but some limitations, as simplified average geometries and/or material properties derived from mechanical tests on animal samples [ 25 , 35 – 37 ] were adopted. The lack of models as computational tools for the physio-mechanical functional investigation of digestive organs is still to overcome and gives some room for further studies and improvements.…”

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Patient-specific stomach biomechanics before and after laparoscopic sleeve gastrectomy

et al. 2022

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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.

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Computational Tools for the Reliability Assessment and the Engineering Design of Procedures and Devices in Bariatric Surgery

Cited by 11 publications

References 46 publications

Computational evaluation of laparoscopic sleeve gastrectomy

Computational evaluation of laparoscopic sleeve gastrectomy

Biomechanical Investigation of the Stomach Following Different Bariatric Surgery Approaches

Patient-specific stomach biomechanics before and after laparoscopic sleeve gastrectomy

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