Clinical efficacy of bowel perfusion assessment during laparoscopic colorectal resection using laser speckle contrast imaging: A matched case–control study

Abstract

IntroductionDisadvantages of bowel perfusion assessment with indocyanine green fluorescence angiography include the need for a fluorophore and the subjective nature of the assessment. This study was performed to evaluate the clinical efficacy of bowel perfusion assessment using laser speckle contrast imaging (LSCI) during laparoscopic colorectal surgery.MethodsThe study population comprised the first 27 consecutive patients who underwent laparoscopic left‐sided colorectal resection with intraoperative perfusion assessment using LSCI. The operative outcomes of these patients were compared with those of a matched group of patients without perfusion assessment. We analyzed the flux data expressed in laser speckle perfusion units.ResultsAfter propensity score matching, we found no significant between‐group differences in the patients' characteristics with the exception of the cancer stage. No patients undergoing LSCI perfusion assessment developed anastomotic leakage, but five (18.5%) patients in the control group did, at a significantly higher rate in male patients (P = .042). There were no significant differences in other operative outcomes. The laser speckle perfusion unit values after ligating marginal vessels were significantly lower than before ligation (P < .01).ConclusionsWith respect to anastomotic leakage, LSCI may improve patient outcomes after colorectal surgery. This technique appears to be a superior tool with the advantages of measurement repeatability and quantitativity and no need for a fluorophore.

Effect of Indocyanine Green Fluorescence Angiography on Anastomotic Leakage in Patients Undergoing Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials and Propensity-Score-Matched Studies

“…Postoperative wound infection was reported in 8 studies (20,31,32,34,36,40,42,45) (2 RCTs, 6 PSM studies), ICG did not reduce the risk of postoperative wound infection, and there was no significant heterogeneity between studies (OR, 0.76; 95% CI, 0.44, 1.32; P = 0.33; I 2 = 0%) (Figure 6B). Both RCTs (20, 40) (OR, 0.52; 95% CI, 0.15, 1.89; P = 0.32; I 2 = 16%) (Table 3) and PSM studies (31,32,34,36,42,45) (OR, 0.84; 95% CI, 0.45, 1.57; P = 0.58; I 2 = 0%) (Table 3) showed that ICG does not reduce the incidence of postoperative wound infection.…”

“…Postoperative wound infection was reported in 8 studies (20,31,32,34,36,40,42,45) (2 RCTs, 6 PSM studies), ICG did not reduce the risk of postoperative wound infection, and there was no significant heterogeneity between studies (OR, 0.76; 95% CI, 0.44, 1.32; P = 0.33; I 2 = 0%) (Figure 6B). Both RCTs (20, 40) (OR, 0.52; 95% CI, 0.15, 1.89; P = 0.32; I 2 = 16%) (Table 3) and PSM studies (31,32,34,36,42,45) (OR, 0.84; 95% CI, 0.45, 1.57; P = 0.58; I 2 = 0%) (Table 3) showed that ICG does not reduce the incidence of postoperative wound infection. Subgroup analysis showed that ICG did not reduce the incidence of postoperative wound infection during colorectal surgery (20,36,40,42) (OR, 0.60; 95% CI, 0.32, 1.15; P = 0.13; I 2 = 0%) (Table 3) or low anterior resection (31,32,34,45) (OR, 1.38; 95% CI, 0.49, 3.89; P = 0.55; I 2 = 0%) (Table 3).…”

“…After excluding 592 duplicate records, 1,025 articles were eliminated by reading titles and abstracts. Full-text evaluation was conducted in the remaining 33 studies, and finally, 20 studies (20,21,26,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) that met the inclusion criteria were included (Figure 1).…”

“…AL rate was reported in all 20 studies (20,21,26,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45).…”

“…Postoperative complications were described in 11 studies (20,21,31,32,34,36,37,(40)(41)(42)45). The total effect size indicated that intraoperative ICG fluorescence angiography did not reduce the incidence of total complications, with significant heterogeneity between studies (OR, 0.93; 95% CI, 0.64, 1.35; P = 0.70; I 2 = 64%) (Figure 5).…”