title: Numerical and experimental analysis of factors leading to suture dehiscence after Billroth II gastric resection.
abstract: The main goal of this study was to numerically quantify risk of duodenal stump blowout after Billroth II (BII) gastric resection. Our hypothesis was that the geometry of the reconstructed tract after BII resection is one of the key factors that can lead to duodenal dehiscence. We used computational fluid dynamics (CFD) with finite element (FE) simulations of various models of BII reconstructed gastrointestinal (GI) tract, as well as non-perfused, ex vivo, porcine experimental models. As main geometrical parameters for FE postoperative models we have used duodenal stump length and inclination between gastric remnant and duodenal stump. Virtual gastric resection was performed on each of 3D FE models based on multislice Computer Tomography (CT) DICOM. According to our computer simulation the difference between maximal duodenal stump pressures for models with most and least preferable geometry of reconstructed GI tract is about 30%. We compared the resulting postoperative duodenal pressure from computer simulations with duodenal stump dehiscence pressure from the experiment. Pressure at duodenal stump after BII resection obtained by computer simulation is 4-5 times lower than the dehiscence pressure according to our experiment on isolated bowel segment. Our conclusion is that if the surgery is performed technically correct, geometry variations of the reconstructed GI tract by themselves are not sufficient to cause duodenal stump blowout. Pressure that develops in the duodenal stump after BII resection using omega loop, only in the conjunction with other risk factors can cause duodenal dehiscence. Increased duodenal pressure after BII resection is risk factor. Hence we recommend the routine use of Roux en Y anastomosis as a safer solution in terms of resulting intraluminal pressure. However, if the surgeon decides to perform BII reconstruction, results obtained with this methodology can be valuable.
authors.affiliation: Faculty of Medical sciences, University in Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia. Electronic address: draleksandarcvetkovic@gmail.com.
authors.forename: Aleksandar M
authors.initials: AM
authors.lastname: Cvetkovic
authors.affiliation: Faculty of Hotel Management and Tourism, Vojvodjanska bb, 36210 Vrnjacka Banja, Serbia; BioIRC, Bioengineering Research and Development Center, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia.
authors.forename: Danko Z
authors.initials: DZ
authors.lastname: Milasinovic
authors.affiliation: Faculty of Engineering, University of Kragujevac, Sestre Janjic 6, 34000 Kragujevac, Serbia.
authors.forename: Aleksandar S
authors.initials: AS
authors.lastname: Peulic
authors.affiliation: BioIRC, Bioengineering Research and Development Center, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia; Faculty of Engineering, University of Kragujevac, Sestre Janjic 6, 34000 Kragujevac, Serbia.
authors.forename: Nikola V
authors.initials: NV
authors.lastname: Mijailovic
authors.affiliation: BioIRC, Bioengineering Research and Development Center, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia; Faculty of Engineering, University of Kragujevac, Sestre Janjic 6, 34000 Kragujevac, Serbia.
authors.forename: Nenad D
authors.initials: ND
authors.lastname: Filipovic
authors.affiliation: Faculty of Medical sciences, University in Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia.
authors.forename: Nebojsa D
authors.initials: ND
authors.lastname: Zdravkovic
mesh_terms: D000818:Animals; D003198:Computer Simulation; D004386:Duodenum / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005763:Gastroenterostomy / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D008954:Models, Biological; D018570:Risk Assessment / Q000379:methods; D013270:Stomach / Q000503:physiopathology* / Q000601:surgery; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000503:physiopathology*; D013537:Sutures / Q000009:adverse effects*; D013552:Swine
keywords: CFD; Computer simulation; Dehiscence; Duodenal stump; Gastric resection