Can indocyanine green during laparoscopic sleeve gastrectomy be considered a new intraoperative modality for leak testing?

Pavone, Giovanna; Fersini, Alberto; Pacilli, Mario; Fazio, Michele De; Panzera, Piercarmine; Ambrosi, Antonio; Tartaglia, Nicola

doi:10.1186/s12893-022-01796-5

Cited by 9 publications

(9 citation statements)

References 28 publications

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“…To the best of our knowledge, this is the rst published study regarding the use of ICG to assess tissue blood supply in OAGB [16][17][18][19][20]. Our ndings support previous data published on detecting ischemia using uorescence in MBS.…”

Section: Discussionsupporting

confidence: 86%

The usefulness of fluorescence in detecting ischemia during bariatric and metabolic surgery

Wityk,

Dowgiałło-Gornowicz,

Bobowicz

2024

Preprint

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Fluorescence is used in various surgical fields to detect tissue ischemia. However, its use in obesity surgery is still limited. This study aims to investigate whether fluorescence can help detect ischemia during metabolic and bariatric surgery and assess its effectiveness in reducing complications. The main objective was to determine the percentage of patients with improper blood flow assessed by fluorescence and the leak rate. The second outcome measured was the morbidity and mortality within 30 days. This single-centre, prospective observational study analysed patients who underwent primary metabolic and bariatric surgery. Data was collected from 66 consecutive patients who qualified for primary one anastomosis gastric bypass and Roux-en-Y gastric bypass procedures. 30-day postoperative morbidity and mortality were assessed. In total, improper blood supply was observed in two cases out of 66 (3%). No leakage incidents were reported. One patient (1.5%) experienced non-ischemic-related complications. No morbidity and mortality were observed 30 days after the surgical procedures. No complications related to ICG administration were observed. This research shows that adding ICG-fluorescence may reduce the number of MBS-related complications, namely leakage secondary to ischemia. However, this field lacks systematic data, and further research with a larger patient group is necessary to establish conclusive evidence.

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Section: Discussionsupporting

confidence: 86%

The usefulness of fluorescence in detecting ischemia during bariatric and metabolic surgery

Wityk,

Dowgiałło-Gornowicz,

Bobowicz

2024

Preprint

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“…Only four publications present the results of over 50 patients [ 18 , 19 , 27 , 28 ], and the largest study group includes 95 patients [ 27 ]. Five studies were case reports that examined one patient each [ 23 – 26 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…In the robotic surgery group, 89 RYGBs and 29 LSGs were performed. Complications occurred in three patients (0.71%): leaks were diagnosed in two cases [ 19 , 24 ], and one patient required a blood transfusion [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, one patient developed a gastric leak and required the insertion of an endoscopic pigtail. The authors concluded that the leak rate was higher in the group of patients without ICG angiography (2.5%) than in the group of patients with intraoperative ICG (1.2%); however, they did not specify statistical significance [ 19 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Fluorescence use in minimally invasive metabolic and bariatric surgery — a systematic review of the literature

Wityk

Dowgiałło-Gornowicz

Feszak

et al. 2023

Langenbecks Arch Surg

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Purpose This review aims to explore and summarise current knowledge of indocyanine green (ICG) fluorescence application in metabolic and bariatric surgery (MBS) and assess its potential in improving patient safety. Methods The review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Evidence from PubMed, ScienceDirect and Ovid MEDLINE databases was independently screened in October 2022. The primary information and outcomes were the type of fluorescence application with potential patient benefit and the complication rate. The secondary outcomes consisted of the kind of dye, the application protocol, and the equipment used. Results Thirteen publications were included, with six prospective observational studies, five case reports and two retrospective cohort studies and involved a total of 424 patients. The publications were categorized into four groups based on the method of fluorescence application. Sixty-six percent of the cases used fluorescence for LSG, 32.3% used it for RYGB, 1.2% for revisional surgery, 0.2% during removal of an adjustable gastric band, and 0.2% for LSG combined with Rossetti fundoplication. ICG was used on its own in the majority of studies, although in one case, it was used in combination with methylene blue. ICG administration protocols varied significantly. Complications occurred in three patients (0.71%): leaks were diagnosed in two cases, and one patient required a blood transfusion. Conclusion The most popular type of use is intraoperative assessment of the blood supply. ICG application may reduce the risk of complications, with potential benefits in detecting ischemia and leaks, searching for bleeding in areas inaccessible to endoscopy, and non-invasive hepatopathy evaluation.

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“…Specifically related to our particular procedure, the robotic platform also allowed the evaluation of the vascular perfusion of the gastric pouch and gastroenteral anastomosis with real-time near-infrared fluorescence after intravenous injection of indocyanine green as a contrast agent. This may be a useful tool in evaluating the risk and preventing the development of postoperative anastomotic leaks [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

First Robotic Roux-en-Y Gastric Bypass for the Treatment of Refractory Gastroesophageal Reflux Disease in a Patient With Systemic Sclerosis

Surjan¹,

Silveira²,

Figueira³

2023

Cureus

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Systemic sclerosis (SSc) is an immune-mediated disease that results in fibrosis of the skin and internal organs. Refractory gastroesophageal reflux disease (GERD) associated with severe esophageal dysmotility is common in SSc patients, and surgical treatment with usual anti-reflux procedures such as fundoplications is associated with dismal symptomatic relief and postoperative dysphagia. We report the first robotic shortlimb Roux-en-Y gastric bypass (RYGB) with a short Roux limb for the treatment of GERD in a patient with SSc with intense esophageal dysmotility. The operative time was two hours. The procedure and postoperative course were uneventful. The patient presented complete relief of gastroesophageal reflux symptoms and no postoperative dysphagia in a two-year follow-up. Therefore, short-limb RYGB is a safe and very effective alternative for the treatment of severe GERD in patients with SSc. The robotic surgical platform may have some advantages compared to conventional laparoscopy.

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Can indocyanine green during laparoscopic sleeve gastrectomy be considered a new intraoperative modality for leak testing?

Cited by 9 publications

References 28 publications

The usefulness of fluorescence in detecting ischemia during bariatric and metabolic surgery

The usefulness of fluorescence in detecting ischemia during bariatric and metabolic surgery

Fluorescence use in minimally invasive metabolic and bariatric surgery — a systematic review of the literature

First Robotic Roux-en-Y Gastric Bypass for the Treatment of Refractory Gastroesophageal Reflux Disease in a Patient With Systemic Sclerosis

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