LAUSR

Respected Editor, Small intestinal measurements and demarcations are essential steps for many bariatric procedures. While clipping the mesentery and stitching of the bowel to demarcate the target segment are proper techniques, we suggest a novel method for intestinal demarcation [1–3]. We use a single 3–0 suture and an 8 Fr (2.7 mm) urine catheter tube in this technique. The length of the tube is fixed at 3 cm (for further subsequent use to demarcate the anastomosis width). First, a single suture and knot are created on either side of the tube to fix the suture thread with the tube (Fig. 1). After we locate the targeted intestinal segment, a single half-layer suture is created near the distal end of the intestine (Fig. 2). Subsequently, the other side of the tube is then sutured and followed by a single suture near the proximal end of the intestine. The demarcation technique is completed without tying any knot to the intestine. The tube can be easily removed by simply cutting the thread (Fig. 3). The tube can then be reused to measure the anastomosis width before extraction. Thus, the tube’s length can be fixed according to the surgeon’s need. We have performed this technique in more than one hundred bariatric procedures. This technique resulted in minimal injury to the intestine, is quick to perform, can have multiple uses, and can be removed easily (leaving no extra foreign objects). Due to the size of the tube, it is difficult to be missed and easy to locate. The only two tools (a suture and a simple elastic tube) needed in this technique are very cost-effective. Thus, it will not create an unnecessary increase in the cost of the procedure. From our perspectives, the demarcation technique of clipping and stitching can easily be missed and difficult to locate. Clipping and stitching can be difficult to remove and will leave extra foreign objects within the abdomen if not extracted. However, we acknowledged that stitching, and especially clipping, is easy to perform.