T Carus1,2, P Pick3. 1. Klinik für Allgemein-, Visceral- und Gefäßchirurgie, Elisabeth-Krankenhaus, Klosterstr. 4, 49832, Thuine, Deutschland. thomas.carus@niels-stensen-kliniken.de. 2. Klinik für Allgemein‑, Visceral- und Gefäßchirurgie, Asklepios Westklinikum Hamburg, Hamburg, Deutschland. thomas.carus@niels-stensen-kliniken.de. 3. Klinik für Allgemein‑, Visceral- und Gefäßchirurgie, Asklepios Westklinikum Hamburg, Hamburg, Deutschland.
Abstract
BACKGROUND: Fluorescence angiography with indocyanine green (ICG-FA) is frequently used in colorectal surgery to assess the blood perfusion in the region of an anastomosis. Previous studies with ICG-FA in both open and laparoscopic surgery could show a low rate of anastomotic leakage, e.g. the PILLAR II study with a leakage rate of 1.4%. This article presents own results, the current status of ICG-FA and the fields of application. OBJECTIVE: The aim of the study was to analyze whether the results obtained so far with ICG-FA are sufficient to recommend an extended use of this relatively new method in colorectal surgery. MATERIAL AND METHODS: From July 2009 to June 2019 a total of 378 colorectal resections (280 colon resections and 98 rectal resections) with intraoperative examination of the anastomosis using ICG-FA were performed. In 13 patients (3.4%) there was reduced intraoperative perfusion, which led to a change in the operative procedure (resection of the anastomosis and new anastomosis, colostomy). RESULTS: The total anastomotic leakage rate was 3.7% with 8 leaks in the colon (2.9%) and 6 in the rectum (6.1%). Without the intraoperative change in 13 patients the rate of leakages could have increased to 7.1% (27/378). The use of ICG-FA in the group of patients studied potentially led to a reduction of the leakage rate by 48%. Current publications show similar results with a potential decrease in the rate of anastomotic leaks in colorectal surgery. CONCLUSION: The results show a very low rate of anastomotic leakage when using ICG-FA. These results are promising in colorectal surgery but controlled randomized studies are lacking and should be carried out before final recommendations can be given.
BACKGROUND: Fluorescence angiography with indocyanine green (ICG-FA) is frequently used in colorectal surgery to assess the blood perfusion in the region of an anastomosis. Previous studies with ICG-FA in both open and laparoscopic surgery could show a low rate of anastomotic leakage, e.g. the PILLAR II study with a leakage rate of 1.4%. This article presents own results, the current status of ICG-FA and the fields of application. OBJECTIVE: The aim of the study was to analyze whether the results obtained so far with ICG-FA are sufficient to recommend an extended use of this relatively new method in colorectal surgery. MATERIAL AND METHODS: From July 2009 to June 2019 a total of 378 colorectal resections (280 colon resections and 98 rectal resections) with intraoperative examination of the anastomosis using ICG-FA were performed. In 13 patients (3.4%) there was reduced intraoperative perfusion, which led to a change in the operative procedure (resection of the anastomosis and new anastomosis, colostomy). RESULTS: The total anastomotic leakage rate was 3.7% with 8 leaks in the colon (2.9%) and 6 in the rectum (6.1%). Without the intraoperative change in 13 patients the rate of leakages could have increased to 7.1% (27/378). The use of ICG-FA in the group of patients studied potentially led to a reduction of the leakage rate by 48%. Current publications show similar results with a potential decrease in the rate of anastomotic leaks in colorectal surgery. CONCLUSION: The results show a very low rate of anastomotic leakage when using ICG-FA. These results are promising in colorectal surgery but controlled randomized studies are lacking and should be carried out before final recommendations can be given.
Entities:
Keywords:
Anastomotic leaks; Indocyanine green; Laparoscopy; Near infrared light; Perfusion
Authors: C Toens; C J Krones; U Blum; V Fernandez; J Grommes; F Hoelzl; M Stumpf; U Klinge; V Schumpelick Journal: Int J Colorectal Dis Date: 2005-08-19 Impact factor: 2.571
Authors: I Mizrahi; M Abu-Gazala; A S Rickles; L M Fernandez; A Petrucci; J Wolf; D R Sands; S D Wexner Journal: Tech Coloproctol Date: 2018-08-10 Impact factor: 3.781
Authors: Mehraneh D Jafari; Steven D Wexner; Joseph E Martz; Elisabeth C McLemore; David A Margolin; Danny A Sherwinter; Sang W Lee; Anthony J Senagore; Michael J Phelan; Michael J Stamos Journal: J Am Coll Surg Date: 2014-09-28 Impact factor: 6.113