Accurate Assessment of Bowel Length: The Method of Measurement Matters

Abstract Purpose Small intestinal length has prognostic significance for patients with short bowel syndrome and accurate measurement of Roux-en-Y limbs is considered important. The flexible elasticity of bowel makes its measurement highly subjective, yet a recommended method for intestinal measurement allowing accurate comparisons between surgeons remains undefined. Measurement of intestinal length has been described, but no comparison of the fidelity of measurement technique has been made. We hypothesized that silk suture and umbilical tape would yield the most consistent measurements. Methods This IRB-approved prospective trial enrolled 12 volunteer surgeons and two IACUC-donated rabbits. Participants were asked to measure short, medium, and long segments of small intestine in a euthanized rabbit using common operating room tools: 18in silk suture, 75cm umbilical tape, 15cm straight ruler, laparoscopic Dorsey bowel graspers. Data were analyzed by ANOVA repeated measures model. Results Over short segments intestinal measurements by grasper were significantly shorter than tape (p=0.002) and ruler (p=0.039). Over medium lengths of bowel measurements by grasper were significantly shorter than suture (p=0.032) and tape (p=0.046), and measurements by ruler also significantly shorter than suture (p=0.008). Over the long intestinal segment measurements by ruler resulted in the greatest variability, and comparison of variance across all possible pairs of groups found significant difference by method of measurement (p=0.049). There was a significant difference in measurements taken along the mesenteric border compared with those taken along the anti-mesenteric border (p=0.001). Conclusions Measurement technique along short segments matters less, however rigid tools underestimate length, and smaller variances in measurement by silk suture and umbilical tape suggest these methods are more reliable across longer distances.