Indocyanine Green Near-Infrared Fluoroangiography Is a Useful Tool in Reducing the Risk of Anastomotic Leakage Following Left Colectomy

Abstract

PurposeTo evaluate whether visualization of the colon perfusion with indocyanine green near-infrared fluoroangiography (ICG-NIFA) reduces the rate of anastomotic leakage (AL) after colorectal anastomosis.MethodsPatients who underwent elective left colectomy, including all procedures involving the sigmoid colon and the rectum with a colorectal or coloanal anastomosis, were retrospectively analyzed for their demographics, operative details, and the rate of AL. Univariate and multivariate analyses were used to compare patients with and without ICG-NIFA-based evaluation.ResultsOverall, our study included 132 colorectal resections [70 sigmoid resections and 62 total mesorectal excisions (TMEs)], of which 70 (53%) were performed with and 62 (47%) without ICG-NIFA. Patients' characteristics were similar between both the groups. The majority of the procedures [91 (69%)] were performed by certified colorectal surgeons, while 41 (31%) operations were supervised teaching procedures. In the ICG-NIFA group, bowel perfusion could be visualized by fluorescence (dye) in all 70 cases, and no adverse effects related to the fluorescent dye were observed. Following ICG-NIFA, the transection line was changed in 9 (12.9%) cases. Overall, 10 (7.6%) patients developed AL, 1 (1.4%) in the ICG-NIFA group and 9 (14.5%) in the no-ICG-NIFA group (p = 0.006). The multivariate analysis revealed ICG-NIFA as an independent factor to reduce AL.ConclusionThese results suggest that ICG-NIFA might be a valuable tool to reduce the rate of AL in sigmoid and rectal resections in an educational setting.

Editorial: Increasing patient’s safe in colorectal surgery via real-time bowel perfusion using near infrared ICG fluorescence studies

“…Despite the magnitude of the main finding from this study, some methodological aspects in the study by Neddermeyer et al ( 1 ) may are worth discussing. My personal approach is to perform ICG prior to bowel transection ( Figure 1A ).…”

“…In a recently published retrospective study Neddermeyer et al ( 1 ) compared the outcomes of two cohorts with and without ICG imaging prior to colorectal or coloanal anastomosis following left-sided colectomy or rectal resection with respect to the rate of AL. Patients with benign (mostly diverticular disease) and malignant pathologies (colorectal cancer) were included in this study.…”

“…This eliminates the need for correcting the transection line prior to anastomosis. Also, the perfusion of the distal bowel (usually the rectum) was not accessed by Neddermeyer et al ( 1 ). The rectal stump could as well be poorly perfused, especially following radical resection for cancer.…”

Vessel-Sparing Lymphadenectomy Should Be Performed in Small Intestine Neuroendocrine Neoplasms

“…Strategically retrograde VS-LA should be performed before the bowel resection [ 14 , 15 ] because the remaining vascularized intestine after mesenteric dissection will guide the extent of bowel resection for vascular purposes. In the case of a macroscopically questionable blood supply, NIR-angiography of the small bowel can be performed to clarify the blood perfusion [ 19 , 22 ].…”

“…In both techniques, the bowel continuity was reconstructed in all cases with a sutured, double-layer side-to-side anastomosis. In cases of macroscopically questionable perfused small bowel ends, Indo-Cyanin-Green (ICG) near infrared angiography was used to determine the blood supply at the anastomotic site as described previously by our group [ 19 ].…”