The Role of Total Small Bowel Length and its Measurement in Metabolic Bariatric Surgery. A Systematic Review

This systematic review evaluated the role and measurement of total small bowel length (TSBL) in metabolic bariatric surgery (MBS) following PRISMA guidelines. Twenty-seven studies involving 6968 adult patients undergoing bariatric surgery with TSBL measurement were included. Outcomes of interest included TSBL, weight loss outcomes, comorbidities improvement/resolution, and the relationship between TSBL and weight loss outcomes. Mean TSBL ranged from 506.5 cm to 795.0 cm. Complications related to TSBL measurement occurred in six patients (0.2%), all small bowel perforations. Nutritional deficiencies ranged from 0.3% to 33.8%. In six studies, tailoring procedures according to TSBL was associated with fewer nutritional deficiencies than in controls. Adoption of standardized TSBL measurement protocol may have a notable impact on surgical outcomes with respect to reducing malabsorptive complications in highly malabsorptive procedures. Key Points circle Measurement of total small bowel length (TSBL) is not a usual practice. circle In the present review mean TSBL ranged from 506.5 cm to 795.0 cm. circle Lowest and highest values of TSBL were 195 cm and 1220 cm, respectively. circle Tailoring the procedure according to TSBL is associated with fewer nutritional deficiencies.