Measuring bowel length during hypo-absorptive surgeries like Roux-en-Y gastric bypass (RYGB) and Single Anastomosis Duodeno-ileal Sleeve (SADI-s) is controversial and usually abandoned due to the high risk of intestinal injury. However, some surgeons, especially in revisional surgery, prefer to count the whole bowel length to avoid leaving very short segments and severe malnutrition afterwards.
3D reconstructed CT scan can be useful in such conditions, avoiding the risk of intestinal injury, but accurate measures might be doubtful.
Patients who are candidates for revisional bariatric surgery
Patients consenting to participate in the study.
Patients with severe adhesions where measuring the small bowel may expose them to unnecessary injuries.
Patients refusing to participate in the study.
Patient refusing CT scan to be done pre-operatively.
Single group
CT
Diagnostic testCT measurment of small bowel
Measuring the small instestine length using pre-marked laparoscopic graspers
Procedure/SurgeryIntra-operatively, the surgeon will assess the length of the small intestine using a 5-cm marked laparoscopic graspers to accurately assess the whole small intestine length.
Accurate small bowel length
the aim of the study to assess if the CT scan with 3D reconstruction will give accurate measures for the bowel length compared to the marked graspers used in laparoscopic surgery
Operative time
measuring the whole bowel length may increase the operative time according to the skills of the surgeon, the presence of adhesions, and short mesentery.
Intestinal Injury
counting the whole bowel length is a tedious procedure, especially in patients with obesity, where the mesentery is dense and may cause injury to the bowel. In this study, we will assess the incidence of intestinal injury of the small bowel, detected intra-operatively or post-operatively.
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