The Role of Total Small Bowel Length and its Measurement in Metabolic Bariatric Surgery. A Systematic Review

This systematic review evaluated the role and measurement of total small bowel length (TSBL) in metabolic bariatric surgery (MBS) following PRISMA guidelines. Twenty-seven studies involving 6968 adult patients undergoing bariatric surgery with TSBL measurement were included. Outcomes of interest included TSBL, weight loss outcomes, comorbidities improvement/resolution, and the relationship between TSBL and weight loss outcomes. Mean TSBL ranged from 506.5 cm to 795.0 cm. Complications related to TSBL measurement occurred in six patients (0.2%), all small bowel perforations. Nutritional deficiencies ranged from 0.3% to 33.8%. In six studies, tailoring procedures according to TSBL was associated with fewer nutritional deficiencies than in controls. Adoption of standardized TSBL measurement protocol may have a notable impact on surgical outcomes with respect to reducing malabsorptive complications in highly malabsorptive procedures.