Accuracy and inter-operator variability of small bowel length measurement at laparoscopy

Gazer, Benny; Rosin, Danny; Bar-Zakai, Barak; Willenz, Udi; Doron, Ofer; Gutman, Mordechai

doi:10.1007/s00464-017-5538-5

Cited by 19 publications

(14 citation statements)

References 26 publications

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“…The study of Gazer et al assessed the reliability of laparoscopic bowel length measurement in 14 surgeons using an in vivo porcine model. They found that measured lengths were 36% shorter than the actual length, concluding that the assessment during laparoscopy was inaccurate [13]. However, the measurements were not performed by bariatric surgeons, which may explain the different outcomes, as general surgeons perform laparoscopic small bowel measurements to a much lesser extent than bariatric surgeons.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Small Bowel Length Measurement in Bariatric Surgery Using a Hand-Over-Hand Technique with Marked Graspers: an Ex Vivo Experiment

et al. 2022

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Introduction Tailoring limb length in bariatric surgery is a subject of many studies. To acquire the optimal limb length, accurate measurement of the small bowel length is essential. Objective To assess the intra- and inter-individual variability of laparoscopic bowel length measurement using a hand-over-hand technique with marked graspers. Method Four bariatric surgeons and four surgical residents performed measurements on cadaver porcine intestine in a laparoscopic box using marked graspers. Each participant performed 10 times a measurement of three different lengths: 150, 180, and 210 cm. Acceptable percentage deviation from the goal lengths was defined as less than 10%, while unacceptable deviations were defined as more than 15%. Results The bariatric surgeons measured the 150-, 180-, and 210-cm tasks with 4% (CI 0.4, 9), − 6% (CI − 11, − 0.8), and 1% (CI − 4, 6) deviation, respectively. In total, the bariatric surgeons estimated 58 out of 119 times (49%) between the margins of 10% deviation and 36 times (30%) outside the 15% margin. Considerable inter-individual differences were found between the surgeons. The surgical residents underestimated the tasks with 12% (CI − 18, − 6), 16% (CI − 19, − 13), and 18% (CI − 22, − 13), respectively. Conclusion Bariatric surgeons estimated bowel length with on average less than 10% deviation. However, this still resulted in 30% of the measurements with more than 15% deviation. There were considerable inter-individual differences between the surgeons and residents structurally underestimated the bowel length. Ascertainment of measurement accuracy and adequate training is essential for bariatric procedures in which limb length is of importance. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Small Bowel Length Measurement in Bariatric Surgery Using a Hand-Over-Hand Technique with Marked Graspers: an Ex Vivo Experiment

et al. 2022

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“…Ten experienced surgeons, each with > 1000 laparoscopic surgeries, were asked to measure various lengths of small bowel without the aid of a measuring tool. Measured small bowel lengths were significantly shorter than in reality and the extent of the measurement error correlated with the length of the measured small bowel segment [ 30 ]. In contrast, Homan et al described the use of a measuring tape, which makes their study results more reliable in this respect.…”

Section: Discussionmentioning

confidence: 99%

Effects of short or long biliopancreatic limb length after laparoscopic Roux-en-Y gastric bypass surgery for obesity: a propensity score-matched analysis

Gass

2022

Langenbecks Arch Surg

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Purpose Although recent studies reported superior weight reduction in patients undergoing Roux-en-Y gastric bypass (RYGB) with long biliopancreatic limb (BPL), no recommendation regarding limb lengths exists. This study compares weight loss and resolution of obesity-related comorbidities in patients undergoing RYGB with either long or short BPL. Methods A retrospective data search from medical records was performed. A total of 308 patients underwent laparoscopic RYGB with a BPL length of either 100 cm or 50 cm. Data was analyzed before and after propensity score matching. Results No statistically significant difference in weight reduction between long and short BPL RYGB in terms of percentage of excess weight loss (%EWL) (86.4 ± 24.5 vs. 83.4 ± 21.4, p = 0.285) and percentage of total weight loss (%TWL) (32.4 ± 8.4 vs. 33.0 ± 8.3, p = 0.543) was found 24 months after surgery. Propensity score–matched analysis did not show any statistically significant difference between groups in both %EWL and %TWL. No significant difference between long and short BPL RYGB in the resolution of obesity-related comorbidities was noted 24 months after surgery. Conclusion Weight loss and resolution of obesity-related comorbidities were not significantly different between long and short BPL RYGB 24 months after surgery.

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“…Measurement of the length of the human small bowel is not just an anatomic data point but is also important for avoiding short (8,10,11). The common feature of these studies is that they were all conducted within the last few years.…”

Section: Discussionmentioning

confidence: 99%

Repeated stretched or non-stretched small bowel length measurements in healthy individuals

Karagül¹,

Kayaalp²

2019

Turk J Surg

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Objective: The aim of the present study was to contribute to the establishment of a standard method of small bowel measurement by comparing repeated small bowel length measurements with and without stretching in healthy individuals. Material and Methods: Small bowel measurement was randomly performed in 24 healthy liver donors. Three repetitive measurements were performed with complete stretching in 12 cases; whereas, 3 consecutive measurements were made without any stretching in the other 12 patients. Living donor hepatectomy continued uneventfully in all cases. Results: In the non-stretched group, the second measurement was 199 cm shorter than the first measurement (p< 0.001). In the third measurement, this shortening had increased further, and the difference from the first measurement was 234 cm on average (p< 0.001). In the stretched group, a shortening of approximately 135 cm between the first and second measurements was noted. In the third measurement, an improvement of 4% was observed in contrast to the non-stretched method, with a mean reduction of 105 cm in the small bowel length compared with the first measurement (p< 0.001). Conclusion: Stretching technique can reduce error rate in repeated small bowel measurements.

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Accuracy and inter-operator variability of small bowel length measurement at laparoscopy

Abstract: Small bowel length assessment during laparoscopy is inaccurate and associated with substantial variability. There is a need to develop a standardized laparoscopic technique for measuring small bowel length which is simple, reproducible, and easy to learn.

Cited by 19 publications

References 26 publications

Laparoscopic Small Bowel Length Measurement in Bariatric Surgery Using a Hand-Over-Hand Technique with Marked Graspers: an Ex Vivo Experiment

Laparoscopic Small Bowel Length Measurement in Bariatric Surgery Using a Hand-Over-Hand Technique with Marked Graspers: an Ex Vivo Experiment

Effects of short or long biliopancreatic limb length after laparoscopic Roux-en-Y gastric bypass surgery for obesity: a propensity score-matched analysis

Repeated stretched or non-stretched small bowel length measurements in healthy individuals

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