Abstract Background Assessment of the total bowel length and its effect on weight loss and nutritional deficiencies is debatable. However, measuring the bowel length, especially in revisional cases, can be of added value. Intra-operative measurement can be time-consuming, with an increased risk of intra- and postoperative complications. 3D CT volumetry might offer a non-invasive, time-saving alternative for accurate Total Bowel Length (TBL) measurement, potentially reducing operative time and associated risks. Aim To compare small bowel length using 3D CT volumetry versus in vivo laparoscopic measurement using pre-marked graspers. Methods Twenty-nine patients were enrolled in this study, who were candidates to undergo revisional bariatric surgeries requiring bowel length estimation (Roux-en-Y bypass, one anastomosis gastric bypass, or revisional bariatric surgery) at Kasr Alainy Hospitals. We compared the 3D CT volumetry-based bowel length measurements preoperatively versus intraoperative measurements, which were estimated in vivo laparoscopically using pre-marked graspers. Results The study included 29 participants (mean age 43.1 years, range 24–65) with an average weight of 109.1 kg, height of 165.8 cm, and BMI of 40.2. The cohort was predominantly female (75.9%). The mean operative time was 151.4 min, with bowel length estimation taking an average of 19.2 min, accounting for 13% of the total operative time. Comparison of radiographic and intraoperative measurements showed that there were no significant differences found for TBL (P = 0.099), BPL (P = 0.684), or CC (P = 0.225); AL demonstrated a significant reduction intraoperatively compared to radiographic assessment (mean ± SD: 185 ± 95 versus 75 ± 37, P = 0.042). The intraclass correlation (ICC) for radiographic and intraoperative measurements showed that radiographic TBL had moderate reliability (P = 0.007); for BPL, AL, and CC, ICC values were lower, with no statistical significance. Conclusion 3D CT volumetry can be considered a reliable and safe method for Total Bowel Length (TBL) assessment, aiding in accurate preoperative planning and contributing to reduced operative time, and avoiding the risks encountered during intraoperative bowel measurements in bariatric surgery.
Abdelsalam et al. (Thu,) studied this question.