Bowel Length Research Articles

1297 Factors Influencing Lymph Node Retrieval and Staging in Colorectal Cancer Resections: A Single-Centre Study

Abstract Aim The American Joint Committee on Cancer (AJCC) recommends examination of a minimum of 12 total dissected lymph nodes to stage rectal cancer accurately. This study aimed to explore the factors influencing lymph node (LN) retrieval and their impact on nodal positivity and N category in colorectal cancer (CRC) staging. Method This retrospective single-centre study included patients with CRC who underwent laparoscopic excision by a single colorectal surgeon between July 2021 and July 2023. Data were extracted from the hospital's electronic database, with exclusion criteria for benign conditions. Results The average number of LNs in this cohort was 17.95±6.55. At least 12 LNs were recovered in 90.91% of the cases. The right colon was the most common tumour site. Right hemicolectomy, transverse colon resection, and sigmoid colectomy achieved 100% compliance with the adequate retrieval criteria. An increase in LN retrieval was observed with higher T stages. A positive linear correlation was observed between the number of harvested LNs and the length of the resected bowel. No significant difference in LN yield was observed between node-positive and node-negative cases. Conclusions Tumour site emerged as a significant factor influencing LN retrieval in CRC resections. While age and sex showed no substantial impact, tumour size and extent of resected bowel positively correlated with LN counts. The overall lymph node yield had no effect on node positivity, indicating that, following a careful inspection of the specimen, a lower lymph node yield may be deemed sufficient.

Outcomes of Children With Short Bowel Syndrome: Experiences in a Multidisciplinary Intestinal Rehabilitation Unit Over Two Decades

BackgroundShort bowel syndrome (SBS) is a rare but serious form of organ failure, and patients with SBS depend on total parenteral nutrition (PN) to maintain growth and development. The present study aimed to evaluate the experiences and outcomes of children with SBS managed by a multidisciplinary intestinal rehabilitation programme in a tertiary paediatric centre. MethodsA retrospective single-centre analysis of all paediatric patients with a clinical diagnosis of SBS between 2001 and 2022 was performed. Clinical outcomes and their predictors were extracted and analysed. ResultsOf the 64 children included in the study, 43 (67%) had extensive necrotising enterocolitis. The median bowel length was 45 cm (interquartile range (IQR) = 18–65) and 18.9% (IQR = 10–28.5) of the expected length based on age. Over a mean follow-up period of 8.9 years, 57 patients (89%) survived, and 50 (78%) weaned off PN. The presence of intestinal failure-associated liver disease (IFALD) (OR = 6.375, p = 0.02) and patients managed before the introduction of fish oil-based PN in 2007 (OR = 5.895, p = 0.001) were significant predictors of mortality. There was an overall improvement in survival over time (p = 0.003). Ultrashort bowel length was not associated with significantly higher mortality (OR = 1.1, p = 0.65) but was a poor prognostic factor for weaning off PN (OR = 3.57, p = 0.004). Among all patients who weaned off PN, two had bowel lengthening procedures and one received a glucagon-like peptide 2 (GLP-2) analogue. ConclusionsA multidisciplinary intestinal rehabilitation programme offers a comprehensive approach for patients with SBS and has been shown to be effective with favourable outcomes. Improvements in the choice of PN and the development of new treatment strategies potentially improved the survival and enteral autonomy of SBS patients. Level of EvidenceIII.

An alternative combined revision of Roux-en-Y gastric bypass: Cover all aspects (of failure)!

The revisional surgical techniques for managing weight regain after laparoscopic Roux-en-Y gastric bypass have lacked a clear gold standard. Various methods such as pouch minimising, gastroenterostomy narrowing and distalization have been described, but none have consistently achieved optimal success. This study introduces a combined revision technique that enables the reassessment of both alimentary limb and biliopancreatic limb lengths based on the individual patient's total bowel length. This approach aims to promote effective weight loss while minimising the pouch and gastroenterostomy.

Evaluation of damage-control surgery in cases of acute mesenteric ischemia for salvaging small bowel length

Evaluation of damage-control surgery in cases of acute mesenteric ischemia for salvaging small bowel length

Post-operative Ultrashort Bowel Syndrome in a Term Neonate: One-year Follow-up

Ultrashort bowel syndrome occurs when the length of the small bowel is below 10–25 cm, or 10% of that expected for age. It is a rare occurrence in neonates; however, when it occurs, it results in high morbidity and mortality. Surviving newborns face a significant detriment in growth and development due to malabsorption of nutrients. A multidisciplinary approach with aggressive parenteral nutrition is the mainstay of management. Our case presented at 20 days of life, with malrotation and midgut volvulus resulting in post-surgical ultrashort bowel syndrome. In spite of being left with only 20 cm of short bowel, the infant survived on conservative management and is thriving well; the infant has been off parenteral nutrition completely since 11 months of age.

Revision/Conversion Surgeries After One Anastomosis Gastric Bypass-An Experts' Modified Delphi Consensus.

There is a lack of evidence for treatment of some conditions including complication management, suboptimal initial weight loss, recurrent weight gain, or worsening of a significant obesity complication after one anastomosis gastric bypass (OAGB). This study was designed to respond to the existing lack of agreement and to provide a valuable resource for clinicians by employing an expert-modified Delphi consensus method. Forty-eight recognized bariatric surgeons from 28 countries participated in the modified Delphi consensus to vote on 64 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus. A consensus was achieved for 46 statements. For recurrent weight gain or worsening of a significant obesity complication after OAGB, more than 85% of experts reached a consensus that elongation of the biliopancreatic limb (BPL) is an acceptable option and the total bowel length measurement is mandatory during BPL elongation to preserve at least 300-400cm of common channel limb length to avoid nutritional deficiencies. Also, more than 85% of experts reached a consensus on conversion to Roux-en-Y gastric bypass (RYGB) with or without pouch downsizing as an acceptable option for the treatment of persistent bile reflux after OAGB and recommend detecting and repairing any size of hiatal hernia during conversion to RYGB. While the experts reached a consensus on several aspects regarding revision/conversion surgeries after OAGB, there are still lingering areas of disagreement. This highlights the importance of conducting further studies in the future to address these unresolved issues.

Ileocecal valve-preservation ileocecostomy (IVPI) in infants with extremely short distal ileum after primary stoma.

Preserving the ileocecal valve (ICV) has shown significant benefits. We present our experience with 18 infants who underwent ileocecal valve-preservation ileocecostomy (IVPI) with an extremely short distal ileum after primary ileostomy. A retrospective analysis was conducted on IVPI cases between 2014 and 2020. Medical records were reviewed, including birth weight, age, primary diseases, length of ileus stump, surgical time and procedure, time to enteral feeding, postoperative hospital stay, and complications. Eighteen patients (male: female = 12:6, median birth weight 1305 (750-4000) g, median gestational age 29 + 5 (27 + 6-39 + 6) weeks) were included in the analysis. Causes of surgery included necrotizing enterocolitis (13), ileocecal intestinal atresia (1), ileum volvulus (2), meconium peritonitis (1), and secondary intestinal fistula (1). The median corrected age of ileostomy closure was 3.2months (2.0-8.0months). The distance from the distal ileal stoma to the ICV ranged from 0.5 to 2cm. The median length of the residual bowel was 90cm (50-130cm). ICV-plasty was performed in 3 cases due to secondary ICV occlusion or stenosis. All patients resumed feeding within 6 to 11days after surgery. The postoperative hospital stay ranged from 12 to 108days (median: 16.5days). Complications included incisional infections in 2 cases, anastomotic stricture and adhesive ileus in 1 case, nosocomial sepsis and septic shock in 1 case. All children showed normal growth and development during a 6-65month follow-up. IVPI is safe and feasible for infants with an extremely short distal ileal stump. ICV-plasty could be applicable for cases with ileocecal occlusion/stenosis.

Improving Inpatient Colonoscopy Bowel Preparation: A Successful Quality Improvement Project.

Inadequate inpatient bowel preparation can lead to repeat procedures, prolonged hospital stays, and increased financial burden. In this quality improvement project, the authors developed an electronic medical record (EMR)-based order set with precise instructions and anticipatory guidance for inpatient bowel preparation before colonoscopy. The current study is a nonrandomized intervention study. The authors compared 2 groups: an intervention group using a newly developed, consensus-based, standardized EMR bowel preparation order set and a control group using previously existing EMR bowel preparation orders. Bowel preparation outcomes were followed over the course of 16 months. The aim was to improve inpatient colonoscopy bowel preparation, as evaluated by the Boston Bowel Preparation Scale, procedure delays, and length of hospital stay. We additionally evaluated the groups' demographics and patient-level factors. A total of 459 inpatient colonoscopies were evaluated over a 16-month period. The intervention group consisted of 227 inpatient colonoscopies, while the control group consisted of 232. The intervention group showed superior Boston Bowel Preparation Scale score and decreased length of hospital stay. The number of adequate bowel preparations increased in the intervention group when compared to the control group from 77% to 86%. The creation of an EMR-based order set is a low-cost and sustainable action that can be easily implemented throughout a hospital system.

Ernica Clinical Consensus Statements on Total Colonic and Intestinal Aganglionosis

BackgroundHirschsprung disease is a congenital intestinal motility disorder characterized by an absence of enteric ganglion cells. Total colonic aganglionosis and near total or total intestinal aganglionosis, defined as absence of ganglion cells in the entire colon and with variable length of small bowel involved, are life-threatening conditions which affect less than 10 % of all patients with Hirschsprung disease. The aim of this project was to develop clinical consensus statements within ERNICA, the European Reference Network for rare congenital digestive diseases, on four major topics: Surgical treatment of total colonic aganglionosis, surgical treatment of total intestinal aganglionosis, management of poor bowel function in total colonic and/or intestinal aganglionosis and long-term management in total colonic and or intestinal aganglionosis. MethodsA multidisciplinary panel of representatives from ERNICA centers was invited to participate. Literature was searched, using specified search terms, in Medline (ALL), Embase and Google Scholar. Abstracts were screened and full text publications were selected. The panel was divided in four groups that extracted data from the full text publications and suggested draft statements for each of the major topics. A modified Delphi process was used to refine and agree on the statements. ResultsThe consensus statement was conducted by a multidisciplinary panel of 24 participants from 10 European countries, 45 statements reached consensus after 3 Delphi-rounds. The availability of high-quality clinical evidence was limited, and most statements were based on expert opinion. Another 25 statements did not reach consensus. ConclusionsTotal colonic and total intestinal aganglionosis are rare variants of Hirschsprung disease, with very limited availability of high-quality clinical evidence. This consensus statement provides statements on the surgical treatment, management of poor bowel function and long-term management for these rare patients. The expert panel agreed that patients benefit from multidisciplinary and personalized care, preferably in an expert center. Type of StudyClinical consensus statement. Level of Evidence3a.

Early use of teduglutide in paediatric patients with intestinal failure is associated with a greater response rate: a multicenter study.

Teduglutide is a glucagon-like-peptide-2 analogue that reduces the need for parenteral support in patients with short bowel syndrome (SBS). Nevertheless, data about long-term therapy with teduglutide in children are still scarce. Our objective was to describe the real-life experience with teduglutide in children with SBS over the last 5years in Spain. This was a national multicentre and prospective study of paediatric patients with intestinal failure (IF) treated with teduglutide for at least 3months. The data included demographic characteristics, medical background, anthropometric data, laboratory assessments, adverse events, and parenteral nutrition (PN) requirements. Treatment response was defined as a > 20% reduction in the PN requirement. The data were collected from the Research Electronic Data Capture (REDCap) database. Thirty-one patients from seven centres were included; the median age at the beginning of the treatment was 2.3 (interquartile range (IQR) 1.4-4.4) years; and 65% of the patients were males. The most frequent cause of IF was SBS (94%). The most common cause of SBS was necrotizing enterocolitis (35%). The median residual bowel length was 29 (IQR 12-40) cm. The median duration of teduglutide therapy was 19 (IQR 12-36) months, with 23 patients (74%) treated for > 1year and 9 treated for > 3years. The response to treatment was analysed in 30 patients. Twenty-four patients (80%) had a reduction in their weekly PN energy > 20% and 23 patients (77%) had a reduction in their weekly PN volume > 20%. Among the responders, 9 patients (29%) were weaned off PN, with a median treatment duration of 6 (IQR 4.5-22) months. The only statistically significant finding demonstrated an association between a > 20% reduction in the weekly PN volume and a younger age at the start of treatment (p = 0.028). Conclusions: Teduglutide seems to be an effective and safe treatment for paediatric patients with IF. Some patients require a prolonged duration of treatment to achieve enteral autonomy. Starting treatment with teduglutide at a young age is associated with a higher response rate. What is Known: • Glucagon-like peptide-2 (GLP-2) plays a crucial role in the regulation of intestinal adaptation in short bowel syndrome (SBS). Teduglutide is a GLP-2 analog that reduces the need for parenteral support in patients with SBS. •Data about long-term therapy with teduglutide in children in real life are still scarce. What is New: • Most pediatric patients with SBS respond in a satisfactory manner to teduglutide treatment. The occurrence of long-term adverse effects is exceptional. • Starting treatment with the drug at a young age is associated with a greater response rate.

Bowel Resection Margins in Crohn's Disease: Do They Matter?

AbstractMany patients with Crohn's disease (CD) will ultimately require surgical intervention for refractory disease despite recognizing that surgery does not cure CD. The initial operation, primarily for ileocolic disease, is focused on resecting the offending pathology and ideally providing a reduced likelihood for subsequent operations and additional bowel loss through surgical techniques. The appropriate margin, macro- vs. microscopic, lays in balance to provide an adequate resection that minimizes bowel loss, compared to an extensive resection which ensures a thorough resection but inherently includes the loss of normal bowel in attempts to reduce recurrent symptomatic disease. Ensuring the appropriately timed operation, performed in optimal conditions, with apt mesenteric resections and an ideal anastomotic configuration are all only part of the equation, as bowel margins play an important role in limiting surgical recurrence and maintaining bowel length. A grossly normal margin assessed by the lack of serositis and the mesenteric “pinch test” can result in an appropriate margin without sacrificing normal bowel in this group of patients who are at risk of further bowel loss from CD recurrence.

Mesenteric sparing approach for advanced nodal extent in small intestinal neuroendocrine tumors. Is there a limit to the vascular resection in order to avoid creating a short small bowel syndrome? An anatomic research study.

By selectively perfusing the first three jejunal arteries (JA), we aim to assess the individual perfusion length of small bowel (SB) and its impact on nodal resection in stage III-up small-intestinal neuroendocrine tumors (SI-NET). Our anatomical research protocol implies a midline laparotomy and three measures of the SB length. We then perform a classical anterior approach of the superior mesenteric vessels. We carry on with the complete dissection and checking of the superior mesenteric artery (SMA) in order to identify the first three JA. Then we selectively perfuse each artery with colored latex solutions and measure the length of small bowel perfused respectively. We conducted our protocol on six cadaveric subjects. Mean(SD) SB length was 413(5.7), 535(13.2), 485(15), 353(25.1), 730(17.3) and 525(16° cm respectively from subject one to six. Most JA originated from the left side of the SMA. The first JA originated from its posterior wall in two subjects. Mean(SD) distance of origin of the first three JA was 4.6(1.3)cm, 6(1.1)cm and 7.1(0.9)cm respectively. Mean(SD) diameter of SMA was 10.8(3.3)mm. Mean diameter of the three first JA was 4(1.4)mm, 4(1.5)mm and 5(1.2)mm respectively. Mean(SD) SB length perfused by first and second JA was 224(14.9)cm, 175(8.6)cm, 238.3(7.6)cm, 84.3(5.1)cm, 233.3(5.8)cm and 218.3(10.4)cm respectively from subject one to six. We observed a trend suggesting that the first and second JA may sustain a SB length beyond the viable 1.5m limit, implying the feasibility of stage III-up SI-NET resection with just two JA.

Technical Considerations in One Anastomosis Gastric Bypass—the Israeli Society of Metabolic and Bariatric Surgery Experience

BackgroundOne anastomosis gastric bypass (OAGB) is gaining popularity worldwide due to its safety and effectiveness. OAGB is the most commonly performed metabolic bariatric surgery (MBS) in Israel. Israel is the only country where OAGB is the most prevalent MBS. Our aim is to address OAGB technical aspects using a national survey completed by members of the Israeli Society of Metabolic and Bariatric Surgery (ISMBS).Materials and MethodsAn online-survey composed of a 17-item–based questionnaire was sent to ISMBS members. All responses were collected and analyzed.ResultsA total of 47/64 (73.4%) ISMBS members participated in the survey. Most surgeons (74.5%) had > 10 years of MBS experience, and most (61.7%) performed > 100 MBS/year. The majority (78.7%) perform OAGB as their most common procedure. Most surgeons fashion a 10–15-cm pouch and use a 36-Fr bougie, (57.4% and 38.3%). Regarding bowel length measurement, 70% use visual estimation and 10.6% routinely measure total small bowel length (TSBL). The most common reasons for creating a longer biliopancreatic limb (BPL) were high body mass index (BMI) and revisional surgery (83.3% and 66%, respectively). In a primary procedure of a patient with a BMI = 40, most (76.6%) would create a 150–200-cm BPL. In patients with a BMI > 50 or revisional cases, most (70.2% and 68.0%) would create a 175–225-cm BPL.ConclusionOAGB is the most prevalent MBS performed in Israel. This survey showed common preferences and variations among ISMBS members. Further studies are needed in order to standardize and build a consensus on OAGB technique.

Measuring Small Bowel Length in Bariatric Surgery: An Ex Vivo Laparoscopic Training Experiment.

Determining limb length in gastric bypass procedures is a crucial step to ensure significant weight loss without risking malnutrition. This study investigated the effect of ex vivo training on the skills needed to determine limb lengths. This was a single-center ex vivo training experiment in a teaching hospital in the Netherlands. We designed a training exercise with marked ropes in a laparoscopic trainer box. All ten surgical residents participated and practiced the skill of estimating limb length. Before and after the two-week period their results on a 150-centimeter limb length task were evaluated. Before training, 10 surgical residents estimated 150centimeters of small bowel with an absolute deviation of 21% [range 9-30]. After the training experiment, the residents measured with 8% [2-20] deviation (P = .17). The 8 residents who trained sufficiently improved statistically significantly to an absolute deviation of 5% [2-17] (P = .012). Over 70% of the participants felt their skills had improved. With sufficient training, surgical residents' skills in measuring small bowel length improved when tested in an ex vivo model. Residents became more confident in their laparoscopic measurement skills. This ex vivo training model is a alternative and addition to on-site training.

Surgical management of complicated Crohn's disease

Surgical management of pediatric Crohn's disease is fundamentally palliative, aiming to treat the sequalae of complicated disease while preserving intestinal length. Multidisciplinary discussion of risk factors and quality of life should take place prior to operative intervention. Though the surgical management of pediatric Crohn's disease is largely based on the adult literature, there are considerations specific to the pediatric population – notably disease and treatment effects on growth and development. Intrabdominal abscess is approached with percutaneous drainage when feasible, reserving surgical intervention for the patient who is unstable or failing medical therapy. Pediatric patients with fibrostenotic disease should be considered for strictureplasty when possible, for maximum preservation of bowel length. Patients with medically refractory Crohn's proctocolitis should be treated initially with fecal diversion without proctocolectomy.

Laparoscopic small bowel length measurement: nonassociative nature of total small bowel length with anthropometric and clinical characteristics in patients undergoing bariatric surgery

BackgroundSmall bowel length (SBL) may have an impact on the outcomes of bariatric surgeries, but it can be difficult to make a direct association between SBL and the safety and outcome of bariatric surgeries. ObjectivesTo address this issue, we set out to devise a predictive model for SBL determination based on clinical and anthropometric variables. SettingAn academic tertiary medical center. MethodsAnthropometric and clinical data, including age, sex, height, weight, and past medical history, were collected upon enrollment. SBL was measured twice during the surgery using a marked grasper. In all cases, measurements were carried out by a single surgeon. To create a predictive model, a 2-step approach was employed. In the first step, linear regression was used to determine influential variables. In the second step, all variables with a P value < .2 were entered into a multivariate regression model. ResultsOverall, 961 bariatric candidates were enrolled. The mean age of the participants was 40.08 years, and 77.5% (n = 745) were female. The mean SBL was 748.90 centimeters. There was a weak but statistically significant positive correlation between SBL with both weight and height. Our univariate linear model determined only anthropometric parameters as a predictor of SBL. The multivariate model also yielded that none of the entered parameters were shown to be accurate predictors of SBL. Moreover, only 4.3% of variances were explainable by this model. ConclusionAlthough we found a weak positive association between height and SBL, this association lacked clinical practicality.

Redefining the Laparoscopic Spatial Sense: AI-Based Intra- and Postoperative Measurement from Stereoimages

A significant challenge in image-guided surgery is the accurate measurement task of relevant structures such as vessel segments, resection margins, or bowel lengths. While this task is an essential component of many surgeries, it involves substantial human effort and is prone to inaccuracies. In this paper, we develop a novel human-AI-based method for laparoscopic measurements utilizing stereo vision that has been guided by practicing surgeons. Based on a holistic qualitative requirements analysis, this work proposes a comprehensive measurement method, which comprises state-of-the-art machine learning architectures, such as RAFT-Stereo and YOLOv8. The developed method is assessed in various realistic experimental evaluation environments. Our results outline the potential of our method achieving high accuracies in distance measurements with errors below 1 mm. Furthermore, on-surface measurements demonstrate robustness when applied in challenging environments with textureless regions. Overall, by addressing the inherent challenges of image-guided surgery, we lay the foundation for a more robust and accurate solution for intra- and postoperative measurements, enabling more precise, safe, and efficient surgical procedures.

Cost-effectiveness of teduglutide in adult patients with short bowel syndrome – a European socioeconomic perspective

BackgroundShort bowel syndrome with intestinal failure (SBS-IF) is a rare but devastating medical condition. An absolute loss of bowel length forces the patients into parenteral support dependency and a variety of medical sequelae, resulting in increased morbidity and mortality. Interdisciplinary treatment may include therapy with the effective but expensive intestinotrophic peptide teduglutide. ObjectivesA time-discrete Markov model was developed to simulate the treatment effect [lifetime costs, quality-adjusted life years (QALYs), and life years (LYs)] of teduglutide plus best supportive care compared with best supportive care alone in patients with SBS-IF. MethodsThe health status of the model was structured around the number of days on PS. Clinical data from 3 data sets were used: 1) an Austrian observational study (base case), 2) pooled observational cohort studies, and 3) a prospective study of teduglutide effectiveness in parenteral nutrition-dependent short bowel syndrome subjects. Direct and indirect costs were derived from published sources. QALYs, LYs, and costs were discounted (3% per annum). ResultsUnder the base case assumption, teduglutide is associated with costs of 2,296,311 € per patient and 10.78 QALYs (13.74 LYs) over a lifetime horizon. No teduglutide is associated with 1,236,816 € and 2.24 QALYs (8.57 LYs). The incremental cost-utility ratio (ICUR) amounts to 123,945 €. In case of the pooled clinical data set, the ICUR increases to 184,961 €. If clinical data based on the study of teduglutide effectiveness in parenteral nutrition-dependent short bowel syndrome subjects were used, the ICUR increased to 235,612 €. ConclusionsTeduglutide in treating patients with SBS-IF meets the traditional cost-effectiveness criteria from a European societal perspective. Nevertheless, the varying concentrations of teduglutide efficacy leave a degree of uncertainty in the calculations.

Occult small bowel adenocarcinoma in Crohn's disease-more than a simple stricture

Small-bowel adenocarcinoma (SBA) accounts for less than 5% of all gastrointestinal cancers. It is generally linked to genetic disorders and immune-mediated inflammatory conditions like Crohn's disease (CD). Despite advances in oncology, SBA has a poor prognosis and high relative risk in this subgroup of patients. Risk factors for the development of SBA in patients with CD include a stricture phenotype and a long- standing disease. This article aims to expose a case of association between CD and SBA and its management. A 66-year-old woman with long-standing terminally ileum-affected CD with multiple admissions due to sub-occlusive episodes and weight loss. CT and MRI revealed intestinal thickening in the small bowel, suggesting an inflammatory stenosis and entero-enteric fistulous tracts. An ileocolectomy was performed, and the patient's histopathological evaluation revealed a mucinous invasive adenocarcinoma of the terminal ileum. The patient was treated with adjuvant chemotherapy and has been under surveillance for two years, without malignant recurrence. Although it is a relatively rare neoplasm, CD patients have a significant risk of developing SBA, when compared to the general population. Diagnosis is challenging due to the occult nature of CD-associated SBA, and imaging and endoscopy alone make it difficult to detect the pathology. Treatment involves a high index of suspicion for the diagnosis and a balance between extended mesenteric resection and CD surgery's primary idea of bowel length preservation. Despite recent advances in oncology, the survival rate in CD-SBA patients remains low. Long-standing CD patients should have the terminal ileum monitored regularly and surgeons should be aware for occult SBA. Post-resection patient surveillance involves regular abdominal exams, serial surveillance, cross-sectional imaging, and monitoring for obstructive symptom recurrence. There is a lack of clear guidelines for primary prevention and surveillance of SBA, with a focus on inflammation management. Preoperative diagnosis techniques are scarce, and patients risk suboptimal treatment if incidental cancer is found. Strategies include right mesenteric-based surgical techniques and/or frozen section exam, always balancing cancer treatment and bowel preservation which is of high relevance in this subgroup of patients.

Correlation of T2DM and Anthropometric Measures with Total Small Bowel Length and Its Effects on Diabetes Remission After Bariatric Surgery.

The outcome of weight loss surgery is related to several factors, and for super-obese patients, the rate of weight loss failure and weight recovery after Roux-en-Y gastric bypass (RYGB) is high. Relevant studies have shown that the weight loss effect also correlates with total small bowel length (TSBL) and biliopancreatic (BP) and Roux limbs. However, there are few studies on the relationship between TSBL and anthropometric parameters, the BP limb, the Roux limb, and weight loss effect, and no relevant reports have been reported in China. The objective was to study the relationship between the total length of the small intestine and anthropometric parameters in the Chinese population. The effect of the Roux limb/biliopancreatic limb (RL/BPL) ratio on weight loss and diabetes remission in RYGB patients 1year after surgery was evaluated to find the appropriate ratio relationship. In this prospective study, 148 patients between the ages of 19 and 68years who underwent laparoscopic Roux-en-Y gastric bypass were enrolled. Height, weight, BMI, the BP limb, the Roux limb, fasting blood glucose (FBG), etc., were noted. To explore the correlation between the total length of the small intestine and these values. Subsequently, the 148 patients were followed up for 1year after surgery. The patients diagnosed with T2DM before surgery were screened out, and 56 patients were finally identified according to the postoperative follow-up, in which BPL = 50cm and RL = 150cm, 175cm, and 200cm, respectively. RL/BPL was divided into 3, 3.5, and 4 groups according to the proportional relationship to explore the relationship between RL/BPL and diabetes remission and weight loss. (1) The study included 148 patients (61 women and 87 men). The mean age was 35.68 ± 10.46years, weight = 127.46 ± 34.51kg, height = 167.83 ± 9.16cm, BMI = 44.94 ± 10.58kg/m2. The average TSBL value was 714.41 ± 101.08 cm. Linear regression analysis showed that TSBL was positively correlated with height, weight, neck circumference, chest circumference, waist circumference, and Roux limb. (2) Fifty-six patients with T2DM who were followed up 1year after surgery were divided into three groups. Group 1: BPL = 50cm, RL = 150cm (n = 20); group 2: BPL = 50cm, RL = 175cm (n = 26); group 3: BPL = 50cm, RL = 200cm (n = 10); RL/BPL = 3 was associated with higher weight loss than the other groups. The remission rate of diabetes did not differ between the three groups. TSBL was positively correlated with height, weight, neck circumference, chest circumference, waist circumference, and Roux limb. The TSBL of males was significantly higher than that of females. Among patients with T2DM who participated in the follow-up 1year after surgery, RL/BPL = 3 (n = 20) had greater weight loss than the other groups.