Yang–Monti–Casale procedure for short bowel syndrome: preliminary geometric analysis

BACKGROUND: Currently autologic reconstructive surgery in the most significant approach in surgical therapy for enteral insufficiency due to short bowel syndrome. Possible application for short bowel surgery of widespread urologic Yang–Monti–Casale technique is an issue of interest. The technique includes cutting of small bowel segment antimesenteric border with a figured incision and second tubularization at an angle to the mesenterium fixation line which results in elongation and narrowing of the bowel segment.

AIM: To determine geometric requirements of small bowel segment for Yang–Monti–Casale procedure to treat short bowel syndrome.

MATERIALS AND METHODS: A mathematical model for resulting bowel segment after Yang–Monti–Casale procedure geometry dependency on original bowel length and width was observed. An object of the analysis was a cylindrical surface. Modeling assumptions were that the suface had no thickness and was unstretchable. Only surfaces with length more than width were taken into account. For establishing the dependency of bowel segment after procedure on original parameters a net of cutted with figured incise according the Yang–Monti–Casale technique cylindrical surface was considered. Bowel segment resulting width was computed as a half of the distance between the points that matched during the enteroplasty. Resulting length was computed as the ratio of the surface area and the resulting width.

RESULTS: Yang–Monti–Casale procedure provides significant bowel segment elongation and narrowing if original bowel length to width ratio is not more than 2,5:1. The target bowel width 20 ± 2 mm is achieveable if original length is 60–80 mm and original width is 30–65 mm.

CONCLUSIONS: Yang–Monti–Casale procedure may be considered as auxiliary technique for short bowel syndrome requiring bowel segment length 60–80 mm, width 30–65 mm, and length to width ratio not more than 2,5:1.