Effect of intestinal pressure on fistula closure during vacuum assisted treatment: A computational approach

INTERNATIONAL JOURNAL OF SURGERY

卷:9

Article

Cattoni, Diego I.¹  Ravazzola, Constanza²  Tuengler, Victoria^3,4  Wainstein, Daniel E.⁵  Chara, Osvaldo^2,6,7 

[1] Univ Montpellier, CNRS, Ctr Biochim Struct, INSERM,U554,UMR 5048, F-34090 Montpellier, France

[2] Univ Buenos Aires, Sch Med, Dept Physiol & Biophys, RA-1121 Buenos Aires, DF, Argentina

[3] Charite Univ Med Berlin, Berlin, Germany

[4] Tech Univ Dresden, Klin Kinder & Jugendmed, D-01307 Dresden, Germany

[5] Gen Acute Hosp Dr E Tornu, RA-1427 Buenos Aires, DF, Argentina

[6] Tech Univ Dresden, Ctr Informat Serv & High Performance Comp, D-01069 Dresden, Germany

[7] UNLP, CONICET, Inst Phys Liquids & Biol Syst, RA-1900 La Plata, Argentina

关键词: Enterocutaneous fistula;    Intestinal pressure;    Fistula radius;    Simulation;    Computational model;   

DOI  :  10.1016/j.ijsu.2011.09.001

来源: Elsevier

【 摘 要 】

Background: Enterocutaneous fistulae, pathological communications between the intestinal lumen and the abdominal skin, can arise as serious complication of gastrointestinal surgery. A current non-surgical treatment for this pathology involves topical application of sub-atmospheric pressure, also known as vacuum assisted closure (VAC). While this technique appears to be promising, surgeons report a number of cases in which its application fails to achieve fistula closure. Here, we evaluate the fistula's physical properties during the vacuum assisted closure process in a computational approach exploring the relevance of intraluminal intestinal pressure. Methods: A mathematical model formulated by differential equations based on tissue elasticity properties and principles of fluid mechanics was created and forcing functions were integrated to mimic intestinal pressure dynamics. A software to solve equations and to fit the model to experimentally obtained data was developed. This enabled simulations of vacuum assisted fistula closure under different intestinal pressure. Results: The simulation output indicates conditions, in which fistula closure can or cannot be expected suggesting favoured or impeded healing, respectively. When modifications of intestinal pressure, as observed in fistula accompanying pathologies, are integrated, the outcome of fistula closure changes considerably. Rise of intestinal pressure is associated with delay of fistula closure and temporary fistula radius augmentation, while reduction of intestinal pressure during sub-atmospheric pressure treatment contributes to a faster and direct fistula closure. Conclusion: From the model predictions, we conclude that administration of intestinal pressure decreasing compounds (e. g. butylscopolamine, glucagon) may improve VAC treatment, while intestinal pressure increasing drugs should be avoided. (C) 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

【 授权许可】

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