Accurate assessment of bowel length: the method of measurement matters.

Autor: Muise ED; Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut., Tackett JJ; Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut., Callender KA; Department of Psychology, Yale University, New Haven, Connecticut., Gandotra N; Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut., Bamdad MC; Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut., Cowles RA; Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut. Electronic address: robert.cowles@yale.edu.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2016 Nov; Vol. 206 (1), pp. 146-150. Date of Electronic Publication: 2016 Jul 18.
DOI: 10.1016/j.jss.2016.07.022
Abstrakt: 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 institutional review board-approved prospective trial enrolled 12 volunteer surgeons and two Institutional Animal Care and Use Committee-donated rabbits. Participants were asked to measure short, medium, and long segments of small intestine in a euthanized rabbit using common operating room tools: 18-in silk suture, 75-cm umbilical tape, 15-cm straight ruler, laparoscopic Dorsey bowel graspers. Data were analyzed by analysis of variance repeated measures model.
Results: Over short segments, intestinal measurements by grasper were significantly shorter than those by tape (P = 0.002) and ruler (P = 0.039). Over medium lengths of bowel, measurements by grasper were significantly shorter than those by suture (P = 0.032) and tape (P = 0.046), and measurements by ruler also were significantly shorter than those by 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 antimesenteric 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 that these methods are more reliable across longer distances.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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