Abstract：
The relatively recent adoption of Endoscopic Sleeve Gastroplasty (ESG) amongst obese patients has gained approval within the surgical community due to its notable benefits, including significant weight loss, safety, feasibility, repeatability, and potential reversibility. However, despite its promising clinical outcomes and reduced invasiveness, there is still a lack of standardised procedures for performing ESG. Multiple suture patterns and stitching methods have been proposed over time, yet rational tools to quantify and compare their effects on gastric tissues are absent. To address this gap, this study proposed a computational approach. The research involved a case study analyzing three distinct suture patterns (C-shaped, U-shaped and Z-shaped) using a patient-specific computational stomach model generated from magnetic resonance imaging. Simulations mimicked food intake by placing wire features in the intragastric cavity to replicate sutures, followed by applying a linearly increasing internal pressure up to 15 mmHg. The outcomes facilitated comparisons between suture configurations based on pressure-volume behaviours and the distribution of maximum stress on biological tissues, revealing the U-shaped as the more effective in terms of volume reduction, even if with reduced elongation strains and increased tissues stresses, whereas the Z-shaped is responsible of the greatest stomach shortness after ESG. In summary, computational biomechanics methods serve as potent tools in clinical and surgical settings, offering insights into aspects that are challenging to explore in vivo, such as tissue elongation and stress. These methods allow for mechanical comparisons between different configurations, although they might not encompass crucial clinical outcomes.
摘要：
最近在肥胖患者中采用内窥镜套管胃成形术（ESG），由于其显着的益处，已在外科界获得批准。包括显著的体重减轻，安全,可行性,重复性,和潜在的可逆性。然而,尽管它有希望的临床结果和降低的侵袭性，仍然缺乏执行ESG的标准化程序。随着时间的推移，已经提出了多种缝合模式和缝合方法，然而，缺乏量化和比较它们对胃组织影响的合理工具。为了解决这个差距，本研究提出了一种计算方法。该研究涉及一个案例研究，分析了三种不同的缝合模式(C形，U形和Z形）使用从磁共振成像生成的患者特定的计算胃模型。模拟通过在胃腔内放置导线特征以复制缝线来模拟食物摄入，然后施加线性增加的内部压力高达15mmHg。结果促进了基于压力-体积行为和生物组织上最大应力分布的缝合线配置之间的比较。揭示U形在体积减小方面更有效，即使伸长应变减少，组织应力增加，而Z形是ESG后最大胃短的原因。总之,计算生物力学方法是临床和手术环境中的有力工具，提供对在体内探索具有挑战性的方面的见解，如组织伸长和应力。这些方法允许不同配置之间的机械比较，尽管它们可能不包括关键的临床结局.
