E. D. Muise1, J. J. Tackett1, K. A. Callender1, N. Gandotra1, M. C. Bamdad1, R. A. Cowles1 1Yale University School Of Medicine,Pediatric Surgery,New Haven, CT, USA
Introduction: Small intestinal length has functional and prognostic significance for patients with short bowel syndrome and accurate measurement of Roux-en-Y limbs is considered important. Factors such as the flexibility and elasticity of the bowel make its measurement highly subjective, but despite this, a recommended method for intestinal measurement allowing accurate comparisons between surgeons and institutions has not been defined. Operative measurement of intestinal length with silk suture, umbilical tape, straight ruler, and laparoscopic graspers has been described in a variety of surgical settings, but no comparison of the fidelity of measurement by each technique has been made. We hypothesized that techniques using silk suture and umbilical tape would yield the most consistent measurements.
Methods: This IRB-approved prospective trial enrolled 12 volunteer surgeons. Participants were asked to measure short, medium, and long segments of small intestine in a euthanized rabbit using common operating room tools (silk suture, umbilical tape, a 15 cm straight ruler, and laparoscopic Dorsey bowel graspers). Data were analyzed by ANOVA repeated measures model.
Results: Over short segments (grand mean M=20.88+/-SEM1.83cm), intestinal measurements by grasper (18.58+/-1.96cm) were significantly shorter than those by tape (23.52+/-2.23cm, p=0.002) or ruler (20.95+/-1.83cm, p=0.039), and not significantly different than measurement by suture (20.50+/-1.82cm, p=0.105). Over medium length (M=37.33 +/-1.29cm), measurements by grasper (34.63+/-1.87cm) were significantly shorter than those by suture (39.09+/-1.19cm, p=0.032) and tape (39.63+/-1.88cm, p=0.046), and measurements by ruler were also significantly shorter than by suture (35.96+/-1.17cm, p=0.008). Over the long segment (M=104.04+/-3.83cm) no significant differences were found between measurement by suture (103.40+/-5.45cm), tape (109.85+/-3.79cm), or ruler (98.88+/-8.34cm). There was a significant difference in measurements taken along the mesenteric border compared with those taken along the anti-mesenteric border of the small bowel (85.33+/-6.64cm vs. 122.75+/-3.83cm, p=0.001).
Conclusion: Over short distances, measurement technique appears to matter less. However, along all three lengths measured, shorter more rigid measurement tools, such as laparoscopic graspers and straight rulers, underestimate length and these errors amplify over longer segments. Smaller variances in measurements by silk suture and umbilical tape suggest these methods are more reliable across longer distances. Finally, measurement along the mesenteric border inherently traverses a shorter distance, and may minimize the variation between surgeons, and highlights that this aspect of measurement is particularly important to standardize.