A biomechanical assessment of laparoscopic sleeve gastrectomy with a patient-specific approach

Obesity has become a global epidemic and bariatric surgery (BS) is one of the most commonly performed gastrointestinal operations thanks to the loss of a large amount of weight and an improvement of patients’ clinical situation. Among different BSs, laparoscopic sleeve gastrectomy (LSG) is currently the most performed procedure worldwide [1], but some limitations still remain and late complications may arise (e.g., GERD). For these reasons, the development of computational patient-specific models represents a valuable solution to overcome these limits and controversies [2]. Indeed, within this work, patient-specific pre- and post-surgical models were extracted from MRI scans of twenty-three patients who underwent LSG [3]. Forty-six computational analyses were realized, focusing on the volumetric gastric reduction after LSG, the mechanical response of the stomach during an inflation process and the elongation strain (LE) distribution at different intragastric pressures. Results were significant in assessing a different mechanical behaviour of pre- and post-surgical stomachs subjected to the same internal gastric pressure. This response can be correlated to unusual activations of mechanoreceptors and thus variation of satiety after LSG. All these insights aim at improving the current knowledge about BS, enhancing postsurgical success and quality of life in the long run. REFERENCES [1] H. Buchwald, D.M. Oien, Metabolic/bariatric surgery worldwide 2011, Obes. Surg. 23 427–436, 2013 https://doi.org/10.1007/s11695-012-0864-0. [2] I. Toniolo, C. Salmaso, G. Bruno, A. De Stefani, C. Stefanini, A.L.T. Gracco, E.L. Carniel, Anisotropic computational modelling of bony structures from CT data: An almost automatic procedure, Comput. Methods Programs Biomed. 189 1–11, 2020 https://doi.org/10.1016/j.cmpb.2020.105319. [3] G. Quero, C. Fiorillo, B. Dallemagne, P. Mascagni, J. Curcic, M. Fox, S. Perretta, The Causes of Gastroesophageal Reflux after Laparoscopic Sleeve Gastrectomy: Quantitative Assessment of the Structure and Function of the Esophagogastric Junction by Magnetic Resonance Imaging and High-Resolution Manometry, Obes. Surg. 30 2108–2117, 2020 https://doi.org/10.1007/s11695-020-04438-y.