Advertisement

Obesity Surgery

, Volume 29, Issue 9, pp 2773–2780 | Cite as

An Experimental Study of Intraluminal Hyperpressure Reproducing a Gastric Leak Following a Sleeve Gastrectomy

  • Lysa Marie
  • Catherine Masson
  • Bénédicte Gaborit
  • Stéphane V. Berdah
  • Thierry BègeEmail author
Original Contributions
  • 140 Downloads

Abstract

Introduction

A gastric leak (GL) represents the main post-operative complication following a sleeve gastrectomy (SG) and occurs most commonly at the top of the stapling, without any clear explanation.

Objective

This experimental study evaluates the biomechanical behavior of post-SG gastric specimens using both insufflation and tensile tests.

Materials and Methods

A total gastrectomy followed by an ex vivo SG was performed in 15 pigs. The “sleeved” stomachs were subjected to intraluminal hyperpressure until failure. Uniaxial circumferential and longitudinal tensile tests were performed using gastric strips obtained from the “resected” stomachs. All the deformations and burst pressures were recorded and analyzed.

Results

A GL appeared in the upper third of the stapling in 73% of cases. The mean burst pressure was 26.3 ± 5.3 mmHg and was significantly correlated with the volume of the “sleeved” stomachs (p = 0.02). The overall deformation of the “sleeved” stomachs was comparable in the frontal (38.3%) and profile (40.5%) planes. The greatest displacement was observed at the failure zone (11 mm on average). The biomechanical behavior of the stomach wall differed according to the strip orientation. The circumferential strips presented a higher strain-to-failure rate (97%) and a lower Young’s modulus (0.99 MPa) when compared to the longitudinal strips (45% and 2.58 MPa, respectively).

Conclusion

This preliminary study reproduced a GL in the same location as observed during clinical practice. The volume of the SG influenced the burst pressure. Further experimental studies and numerical simulations should evaluate the impact of shape modifications on an SG.

Keywords

Obesity Sleeve gastrectomy Gastric leak Hyperpressure Biomechanical behavior 

Notes

Acknowledgments

The authors would like to warmly thank Marie-Ange Beccaris for her assistance during surgical procedures.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Statements Regarding Ethics and Consent

The study has been performed in accordance with the ethical standards.

References

  1. 1.
    Matta J, Carette C, Rives Lange C, et al. French and worldwide epidemiology of obesity. Presse Med. 2018;47(5):434–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20(5):535–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641.Google Scholar
  4. 4.
    Kwok CS, Pradhan A, Khan MA, et al. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol. 2014;173(1):20–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Yska JP, van Roon EN, de Boer A, Leufkens HG, Wilffert B, de Heide LJ, de Vries F, Lalmohamed A. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery: a population-based cohort study in the United Kingdom. JAMA Surg. 2015;150(12):1126–33.  https://doi.org/10.1001/jamasurg.2015.2398.CrossRefPubMedGoogle Scholar
  6. 6.
    Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313(1):62–70.CrossRefPubMedGoogle Scholar
  7. 7.
    Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Halperin F, Ding SA, Simonson DC, Panosian J, Goebel-Fabbri A, Wewalka M, Hamdy O, Abrahamson M, Clancy K, Foster K, Lautz D, Vernon A, Goldfine AB. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. JAMA Surg. 2014;149(7):716–26.  https://doi.org/10.1001/jamasurg.2014.514.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sundbom M. Laparoscopic revolution in bariatric surgery. World J Gastroenterol. 2014;20(41):15135–43.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.CrossRefPubMedGoogle Scholar
  11. 11.
    Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Cesana G, Cioffi S, Giorgi R, et al. Proximal leakage after laparoscopic sleeve gastrectomy: an analysis of preoperative and operative predictors on 1738 consecutive procedures. Obes Surg. 2018;28(3):627–35.CrossRefPubMedGoogle Scholar
  13. 13.
    Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009 Dec;19(12):1672–7.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Rawlins L, Rawlins MP, Teel D. Human tissue thickness measurements from excised sleeve gastrectomy specimens. Surg Endosc. 2014;28(3):811–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Perez M, Brunaud L, Kedaifa S, et al. Does anatomy explain the origin of a leak after sleeve gastrectomy? Obes Surg. 2014;24(10):1717–23.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Delko T, Hoffmann H, Kraljević M, et al. Intraoperative patterns of gastric microperfusion during laparoscopic sleeve gastrectomy. Obes Surg. 2017;27(4):926–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Mion F, Tolone S, Garros A, et al. High-resolution impedance manometry after sleeve gastrectomy: increased intragastric pressure and reflux are frequent events. Obes Surg. 2016;26(10):2449–56.CrossRefPubMedGoogle Scholar
  18. 18.
    Massalou D, Masson C, Foti P, et al. Dynamic biomechanical characterization of colon tissue according to anatomical factors. J Biomech. 2016;49(16):3861–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy--volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Yuval JB, Mintz Y, Cohen MJ, et al. The effects of bougie caliber on leaks and excess weight loss following laparoscopic sleeve gastrectomy. Is there an ideal bougie size? Obes Surg. 2013;23(10):1685–91.CrossRefPubMedGoogle Scholar
  22. 22.
    Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Natoudi M, Theodorou D, Papalois A, et al. Does tissue ischemia actually contribute to leak after sleeve gastrectomy? An experimental study. Obes Surg. 2014;24(5):675–83.CrossRefPubMedGoogle Scholar
  24. 24.
    Causey MW, Fitzpatrick E, Carter P. Pressure tolerance of newly constructed staple lines in sleeve gastrectomy and duodenal switch. Am J Surg. 2013;205(5):571–4. discussion 574–5CrossRefPubMedGoogle Scholar
  25. 25.
    Huang R, Gagner M. A thickness calibration device is needed to determine staple height and avoid leaks in laparoscopic sleeve gastrectomy. Obes Surg. 2015;25(12):2360–7.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Carniel EL, Mencattelli M, Bonsignori G, Fontanella CG, Frigo A, Rubini A, Stefanini C, Natali AN. Analysis of the structural behaviour of colonic segments by inflation tests: experimental activity and physio-mechanical model. Proc Inst Mech Eng H. 2015;229(11):794–803.  https://doi.org/10.1177/0954411915606484.CrossRefGoogle Scholar
  27. 27.
    Carniel EL, Frigo A, Fontanella CG, et al. A biomechanical approach to the analysis of methods and procedures of bariatric surgery. J Biomech. 2017;56:32–41.CrossRefPubMedGoogle Scholar
  28. 28.
    Zhao J, Liao D, Chen P, et al. Stomach stress and strain depend on location, direction and the layered structure. J Biomech. 2008;41(16):3441–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Jia ZG, Li W, Zhou ZR. Mechanical characterization of stomach tissue under uniaxial tensile action. J Biomech. 2015;48(4):651–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Aydin RC, Brandstaeter S, Braeu FA, et al. Experimental characterization of the biaxial mechanical properties of porcine gastric tissue. J Mech Behav Biomed Mater. 2017;74:499–506.CrossRefPubMedGoogle Scholar
  31. 31.
    Liao D, Zhao J, Gregersen H. A novel 3D shape context method based strain analysis on a rat stomach model. J Biomech. 2012;45(9):1566–73.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Digestive Surgery, Hôpital NordAix-Marseille UniversityMarseilleFrance
  2. 2.Laboratory of Applied Biomechanics UMRT24Aix-Marseille University / IFSTTARMarseilleFrance
  3. 3.Department of Endocrinology, Metabolic Diseases and Nutrition, Hôpital NordAix-Marseille UniversityMarseilleFrance

Personalised recommendations