Computational Tools for the Reliability Assessment and the Engineering Design of Procedures and Devices in Bariatric Sur
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Annals of Biomedical Engineering (Ó 2020) https://doi.org/10.1007/s10439-020-02542-9
Original Article
Computational Tools for the Reliability Assessment and the Engineering Design of Procedures and Devices in Bariatric Surgery C. SALMASO,1,2 I. TONIOLO ,1,2 C. G. FONTANELLA,1,2 P. DA ROIT,2 A. ALBANESE,4 L. POLESE,1,4 C. STEFANINI,3 M. FOLETTO,1,4 and E. L. CARNIEL1,2 1 Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy; 2Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131 Padua, Italy; 3The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy; and 4Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
(Received 10 January 2020; accepted 27 May 2020) Associate Editor Umberto Morbiducci oversaw the review of this article.
Abstract—Obesity is one of the main health concerns worldwide. Bariatric Surgery (BS) is the gold standard treatment for severe obesity. Nevertheless, unsatisfactory weight loss and complications can occur. The efficacy of BS is mainly defined on experiential bases; therefore, a more rational approach is required. The here reported activities aim to show the strength of experimental and computational biomechanics in evaluating stomach functionality depending on bariatric procedure. The experimental activities consisted in insufflation tests on samples of swine stomach to assess the pressure-volume behaviour both in pre- and post-surgical configurations. The investigation pertained to two main bariatric procedures: adjustable gastric banding (AGB) and laparoscopic sleeve gastrectomy (LSG). Subsequently, a computational model of the stomach was exploited to validate and to integrate results from experimental activities, as well as to broad the investigation to a wider scenario of surgical procedures and techniques. Furthermore, the computational approach allowed analysing stress and strain fields within stomach tissues because of food ingestion. Such fields elicit mechanical stimulation of gastric receptors, contributing to release satiety signals. Pressure-volume curves assessed stomach capacity and stiffness according to the surgical procedure. Both AGB and LSG proved to reduce stomach capacity and to increase stiffness, with markedly greater effect for LSG. At an internal pressure of 5 kPa, outcomes showed that in pre-surgical configuration the inflated volume was about 1000 mL, after AGB the inflated volume was slightly lower, while after LSG it fell significantly, reaching 100 mL. Computational modelling techniques showed the influence of bariatric intervention on mechanical stimulation
Address correspondence to I. Toniolo, Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131 Padua, Italy. Electronic mail: [email protected] C. Salmaso and I. Toniolo equally contributed to the present study.
of gastric receptors due to food ingestion. AGB markedly enhanced the mechanical stimulation within the fundus region, while LSG significantly reduced stress and strain i
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