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Background <p>Accurate assessment of small bowel length is essential for Roux-en-Y gastric bypass (RYGB), yet intraoperative measurement is technically challenging and prone to variability. Advances in three-dimensional computed tomography (3D-CT) reconstruction may allow reliable preoperative estimation, although this approach has not been validated in individuals with severe obesity undergoing metabolic and bariatric surgery (MBS).</p> Methods <p>This single-center prospective observational study included adults with severe obesity undergoing laparoscopic RYGB. All participants underwent preoperative contrast-enhanced CT with semi-automated 3D reconstruction and centerline-based bowel unfolding. Intraoperative small bowel length was measured twice using standardized laparoscopic techniques. Agreement between methods was assessed using Pearson correlation, linear regression, and Bland–Altman analysis. An ex vivo porcine model was used to evaluate non-linear elongation under varying loads.</p> Results <p>Twenty-one participants were included. CT-estimated bowel length (524.5 ± 73.5&#xa0;cm) strongly correlated with intraoperative measurement (761.9 ± 152.3&#xa0;cm) (<i>r</i> = 0.811; <i>p</i> &lt; 0.001; R² = 0.658). Bland–Altman analysis demonstrated systematic underestimation by CT (bias + 237.4&#xa0;cm; limits of agreement + 37.2 to + 437.6&#xa0;cm). Higher BMI correlated with greater discrepancy (<i>r</i> = 0.503; <i>p</i> = 0.020). Ex vivo experiments confirmed non-linear, load-dependent elongation.</p> Conclusions <p>Although CT-based reconstruction underestimates absolute bowel length, it shows strong correlation with intraoperative measurement and may serve as a preoperative stratification tool. These findings support development of correction models to enable individualized limb-length planning in MBS.</p> Graphical Abstract <p></p>

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Clinical Validation of a CT-Based 3D Digital Reconstruction System for Preoperative Small Bowel Length Assessment in Candidates for Roux-en-Y Gastric Bypass

  • 期刊论文

  • 发表日期：

    2026年4月20日

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  • Ma Dolores Frutos Bernal,
  • Alfonso Aliaga Rodríguez,
  • Alvaro Martínez Espí,
  • Juan Manuel Franco Reverte,
  • Lucas Antonio Díaz Martínez,
  • Nuria Segura Montiel,
  • Arabia Castro Morales,
  • Natalia León Navarro,
  • Andrés Balaguer Román

摘要

Background

Accurate assessment of small bowel length is essential for Roux-en-Y gastric bypass (RYGB), yet intraoperative measurement is technically challenging and prone to variability. Advances in three-dimensional computed tomography (3D-CT) reconstruction may allow reliable preoperative estimation, although this approach has not been validated in individuals with severe obesity undergoing metabolic and bariatric surgery (MBS).

Methods

This single-center prospective observational study included adults with severe obesity undergoing laparoscopic RYGB. All participants underwent preoperative contrast-enhanced CT with semi-automated 3D reconstruction and centerline-based bowel unfolding. Intraoperative small bowel length was measured twice using standardized laparoscopic techniques. Agreement between methods was assessed using Pearson correlation, linear regression, and Bland–Altman analysis. An ex vivo porcine model was used to evaluate non-linear elongation under varying loads.

Results

Twenty-one participants were included. CT-estimated bowel length (524.5 ± 73.5 cm) strongly correlated with intraoperative measurement (761.9 ± 152.3 cm) (r = 0.811; p < 0.001; R² = 0.658). Bland–Altman analysis demonstrated systematic underestimation by CT (bias + 237.4 cm; limits of agreement + 37.2 to + 437.6 cm). Higher BMI correlated with greater discrepancy (r = 0.503; p = 0.020). Ex vivo experiments confirmed non-linear, load-dependent elongation.

Conclusions

Although CT-based reconstruction underestimates absolute bowel length, it shows strong correlation with intraoperative measurement and may serve as a preoperative stratification tool. These findings support development of correction models to enable individualized limb-length planning in MBS.

Graphical Abstract