Computer simulation at the duodenal stump after gastric resection

There are various types of reconstruction of gastrointestinal continuity after gastric resection. It seems that insufficient attention has been paid to how the geometry and flow conditions affect the gastroduodenal system after distal gastric resection. Also, intraluminal pressure can be the dominant cause of duodenal suture dehiscence, but still many pathological mechanisms involved in this surgical problem remain unclear.

A research article to be published on April 28, 2009 in the World Journal of Gastroenterology addresses this question. The research team led by Prof. Filipovic from University of Kragujevac used computer simulation, which was based on a finite element method, to study flow and mixing in the duodenal junction after distal gastric resection and a Billroth 2 procedure.

Using the finite element method, two different Billroth 2 procedure cases (A and B) were modeled. Case A was defined with a shorter and almost straight duodenal section, while case B has a much longer and curved duodenal section. Velocity, pressure and food concentration distribution were determined and the numerical results were compared with experimental observations.

The pressure distribution obtained by numerical simulation was in the range of the recorded experimental results. They found that case A had a more favorable pressure distribution in comparison with case B. However, case B had better performance in terms of food transport because of more continual food distribution, as well as better emptying of the duodenal section. This study offers insight into the transport process within the duodenal stump section after surgical intervention, which can be useful for future patient-specific predictions of a surgical outcome.