Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Matta J, Carette C, Rives Lange C, et al. French and worldwide epidemiology of obesity. Presse Med. 2018;47(5):434–8.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  6. Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313(1):62–70.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sundbom M. Laparoscopic revolution in bariatric surgery. World J Gastroenterol. 2014;20(41):15135–43.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  14. Rawlins L, Rawlins MP, Teel D. Human tissue thickness measurements from excised sleeve gastrectomy specimens. Surg Endosc. 2014;28(3):811–4.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  20. Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy--volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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 574–5

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  29. Jia ZG, Li W, Zhou ZR. Mechanical characterization of stomach tissue under uniaxial tensile action. J Biomech. 2015;48(4):651–8.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, chemin des Bourrely, 13915 cedex 20, Marseille, France

    Lysa Marie, Stéphane V. Berdah & Thierry Bège

  2. Laboratory of Applied Biomechanics UMRT24, Aix-Marseille University / IFSTTAR, Marseille, France

    Catherine Masson, Stéphane V. Berdah & Thierry Bège

  3. Department of Endocrinology, Metabolic Diseases and Nutrition, Hôpital Nord, Aix-Marseille University, chemin des Bourrely, 13915 cedex 20, Marseille, France

    Bénédicte Gaborit

Authors
  1. Lysa Marie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catherine Masson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bénédicte Gaborit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stéphane V. Berdah
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thierry Bège
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thierry Bège.

Ethics declarations

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.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marie, L., Masson, C., Gaborit, B. et al. An Experimental Study of Intraluminal Hyperpressure Reproducing a Gastric Leak Following a Sleeve Gastrectomy. OBES SURG 29, 2773–2780 (2019). https://doi.org/10.1007/s11695-019-03924-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-019-03924-2

Keywords

Search

Navigation