Abstract
INTRODUCTION: The method for assessing the bowel length is debatable but crucial in bariatric surgeries, especially revisional ones. It may be linked to improved weight loss and reducing nutritional deficiencies; however, it can be time-consuming, increasing the likelihood of complications during and after the surgery. 3D CT volumetry could offer a non-invasive, time-saving alternative for accurate Total Bowel Length (TBL) measurement, potentially reducing operative time and associated risks. OBJECTIVE: This study compares small bowel length using 3D CT volumetry versus in vivo laparoscopic measurement with pre-marked graspers, and assesses the time consumed intra-operatively for TBL measurement in cases of revisional bariatric surgery. METHODS: This cross-sectional study included 34 bariatric surgery candidates undergoing revisional or conversion bariatric surgery requiring bowel length estimation. Surgeries included Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), one-anastomosis gastric bypass (OAGB), banded Roux-en-Y gastric bypass (banded RYGB), and distalization. Pre-operatively, 3D CT volumetry-based bowel length measurements were performed and interpreted by the same radiologist, and compared with intraoperative bowel measurements, which were estimated in vivo laparoscopically using pre-marked graspers. A single surgeon did all the surgical procedures. RESULTS: The participants had an average age of 42.0 years and a mean BMI of 40.4 ± 7.6 kg/m². The cohort was predominantly female (73.5%). The bowel length estimation took an average of 19 ± 4 min intra-operatively. A comparison of radiographic and intraoperative measurements showed no significant differences for TBL (P = 0.264). The intraclass correlation (ICC) for radiographic and intraoperative measurements showed that radiographic TBL shows acceptable consistency (P = 0.007). CONCLUSION: 3D CT volumetry can be considered a reliable and safe method for TBL assessment. It aids in accurate preoperative planning, reduces operative time, and avoids the risks encountered during intraoperative bowel measurements in bariatric surgery. KEY POINTS: • An ideal bowel length should achieve effective weight loss while minimizing nutritional deficiencies. • Estimation of total bowel length using 3D CT volumetry shows reliable results compared to intraoperative measurements. • Estimation of total bowel length using 3D CT volumetry minimizes operative time.