Document Detail


Effect of intestinal pressure on fistula closure during vacuum assisted treatment: A computational approach.
MedLine Citation:
PMID:  21945673     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Enterocutaneous fistulae, pathological communications between the intestinal lumen and 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 about 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 integrated to mimic intestinal pressure dynamics. A software was developed to solve the equations and fitted the model to experimentally obtained data allowing the simulation of vacuum assisted fistula closure under different intestinal pressure regimes. RESULTS: The simulation output indicates conditions where 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.
Authors:
Diego I Cattoni; Constanza Ravazzola; Victoria Tüngler; Daniel E Wainstein; Osvaldo Chara
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Publication Detail:
Type:  -     Date:  2011-9-16
Journal Detail:
Title:  International journal of surgery (London, England)     Volume:  -     ISSN:  1743-9159     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101228232     Medline TA:  Int J Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Centre de Biochimie Structurale, INSERM U554, Université de Montpellier, CNRS UMR 5048, 29 rue de Navacelles, 34090 Montpellier Cedex, France.
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