Mechanomedicine in digestive surgery: a theranostic framework integrating mechanical diagnostics and therapeutic modulation across the perioperative continuum.

Abstract

Digestive surgery remains burdened by anastomotic leakage, postoperative obstruction, and highly variable functional recovery, even when operations are anatomically successful. Accumulating evidence indicates that these complications arise not only from morphology, but also from an unmeasured and unmodulated mechanical microenvironment, including tissue stiffness, anastomotic tension, perfusion-related shear stress, and intra-abdominal pressure. This review outlines a mechanomedicine framework for digestive surgery that treats these mechanical cues as actionable theranostic variables across the perioperative continuum, integrating mechanical diagnostics with targeted mechanical therapeutics. Multiscale biomechanics and mechanotransduction are first considered in relation to healing and fibrosis in the gastrointestinal tract. Preoperative mechanical profiling, using in vivo diagnostic techniques such as magnetic resonance elastography (MRE) and ultrasound shear-wave elastography (SWE), may refine surgical indications and support virtual surgical planning. Intraoperative mechanosensing tools, including functional lumen imaging, quantitative fluorescence perfusion, and portal pressure measurements, may provide real-time diagnostic thresholds to guide anastomotic site selection, reconstruction strategy, and resection extent. In vitro diagnostic platforms, including organ-on-chip models and mechanosensitive biosensors, have further clarified the mechanobiological basis of surgical complications and are informing the design of mechanoresponsive therapeutic systems. Postoperative mechanotherapy, encompassing continuous intra-abdominal pressure monitoring, mechanically tuned scaffolds, early mobilization, and mechanoresponsive drug-delivery systems, may contribute to early warning and personalized rehabilitation. Ethical and equity considerations are also relevant to this framework, including algorithmic bias, data governance, and equitable access across diverse healthcare settings. Together, these advances support a theranostic paradigm in which the same mechanical signals that diagnose risk may also help trigger, guide, or personalize therapy, pointing to a future in which digestive surgery is planned, performed, and followed up with more explicit and integrated control of the mechanical microenvironment to reduce complications and improve long-term function.