Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis

Blanco‐Colino, Ruth; Espín‐Basany, Eloy

doi:10.1007/s10151-017-1731-8

Cited by 259 publications

(205 citation statements)

References 43 publications

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“…Although they found a 6.1% rate of skin necrosis in the non-ICGA group versus 2.2% in the ICGA group, this difference was not statistically significant [29]. In addition to the assessment of abdominal skin and ALT flap perfusion, ICGA serves as an effective tool to assess anastomotic bowel perfusion [30]. Moreover, it could have a role in reducing anastomotic leakage rates following ECF resection, which reflects the potential for implementation of ICGA in reconstructive abdominal wall surgery.…”

Section: Discussionmentioning

confidence: 99%

Fasciocutaneous anterolateral thigh flaps for complex abdominal wall reconstruction after resection of enterocutaneous fistulas and the role of indocyanine green angiography: a pilot study

Pruimboom

Ploegmakers

Bijkerk

et al. 2020

Hernia

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Purpose No previous study reported the use of a fasciocutaneous anterolateral thigh (ALT) flap combined with a biological mesh for abdominal wall reconstruction (AWR) after enterocutaneous fistula (ECF) in a single-staged procedure and the use of Indocyanine Green Angiography (ICGA) intraoperatively. The purpose of this study was to determine the feasibility and safety of this procedure and to examine the added value of ICGA in minimizing postoperative complications. Methods A single-institution review of a prospectively maintained database was conducted at Maastricht University Medical Center. To evaluate the feasibility and safety of this procedure, early (≤ 30 days) and late (> 30 days) postoperative complications were assessed. ECF recurrence was considered the primary outcome. To examine the added value of ICGA, complications in the ICGA group and the non-ICGA group were compared descriptively. Results Ten consecutive patients, with a mean age of 66.7 years, underwent a single-staged AWR with fasciocutaneous ALT flaps. Mean follow-up was 17.4 months (4.3-28.2). Two early ECF recurrences were observed. Both restored without the need for reoperation. A lower rate of early complications was observed in the ICGA group compared to the non-ICGA group. Conclusion The combination of a biological mesh and fasciocutaneous ALT flap is feasible and safe in AWR after ECF repair in a single-staged approach, with an acceptable complication rate in a cohort of complex patients operated in a dedicated center. ECF closure was achieved in all patients. ICGA seems to be of great added value in minimizing postoperative complications during AWR.

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Section: Discussionmentioning

confidence: 99%

Fasciocutaneous anterolateral thigh flaps for complex abdominal wall reconstruction after resection of enterocutaneous fistulas and the role of indocyanine green angiography: a pilot study

Pruimboom

Ploegmakers

Bijkerk

et al. 2020

Hernia

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“…Clearly, avoidance of ischaemia during the initial fashioning of the anastomosis is important. A recent multi‐institutional study (PILLAR II) and a systematic review and meta‐analysis suggest that intra‐operative use of indocyanine green fluorescence imaging may reduce the risk of AL in colorectal surgery by ensuring adequate perfusion of the anastomosis. Perfusion assessment before making the anastomosis may prevent anastomotic ischaemia as a postoperative complication.…”

Section: Discussionmentioning

confidence: 99%

Recurrence of rectal anastomotic leakage following stoma closure: assessment of risk factors

et al. 2019

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Aim In patients with a previous history of rectal anastomotic leakage (AL), the surgical indications and timing for closure of a diverting stoma have to be carefully judged. Even if AL has apparently healed before stoma closure, re‐leakage may occur after closure. The aim of this study was to determine the incidence and risk factors for recurrent AL following stoma closure. We also examined the treatment strategies aiming to minimize the risk of recurrent AL. Methods From January 2009 to December 2016, 1008 patients underwent sphincter‐saving surgery [low anterior resection, all‐sphincter‐preserving rectal resection with hand‐sewn coloanal anastomosis (CAA) and intersphincteric resection (ISR)] for primary rectal cancer with curative intent at our hospital. A total of 69 patients with AL with a Clavien–Dindo Grade III or more who subsequently underwent closure of a diverting stoma were retrospectively reviewed for this study. Results The incidence of recurrent leakage after stoma closure in this series was 13% overall with an incidence of 25% in the CAA/ISR group and 5% in the low anterior resection group. Significant risk factors included hand‐sewn anastomosis (P = 0.0257) compared to stapled anastomosis, ischaemia at the anastomotic site as the cause of initial AL (P < 0.001) and a shorter interval between confirmation of healing and stoma closure (P = 0.00952). Conclusion Ischaemia at the anastomotic site was the main risk factor for recurrent leakage, particularly after CAA/ISR. Additional treatment options before stoma closure should be considered to avoid re‐leakage in such cases.

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“…Our utilization of IFI reduced the AL rate by half, in agreement with a recent meta-analysis, which found that the AL rate in rectal cancer operations was significantly lower with than without IFI (1.1% vs 6.1%). 22 Although the primary cause of AS is regarded as chronic ischemia around the anastomotic site, objective observations are still unavailable. Reduced IFI intensity was the independent parameter that correlated with AS.…”

Section: Discussionmentioning

confidence: 99%

Mechanotechnical faults and particular issues of anastomotic complications following robot‐assisted anterior resection in 968 rectal cancer patients

Kim

Lee

Kim

et al. 2019

Journal of Surgical Oncology

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Background As most risk factors for anastomotic complications (AC) in rectal cancer patients appear to be noncorrectable, it is needed to find the correctable causes. Additionally, the outcomes of indocyanine‐green fluorescence imaging (IFI) and robot‐stapled anastomosis have yet been undetermined. Methods This study retrospectively analyzed 968 consecutive patients with rectal cancer, who underwent curative robot‐assisted anterior resections between 2010 and 2018. IFI parameters and stapling features in the surgical records were reviewed, and reconfirmed. Results AC occurred in 54 patients (5.6%), 34 (3.5%) with anastomotic leakage (AL) and 24 (2.5%) with anastomotic stenosis (AS). Mechanotechnical faults including defective stapling configurations, including angles lesser than or equal to 150° and outer deviation (more than half from the center of the circle) of linear staples, between the two linear staples were independently associated with AL (P < .001 each). IFI significantly reduced AL rate (2.5% vs 5.3%, P = .029) and AS rate (2% vs 18.8%, P = .006), respectively. Robot linear stapling enabled to maintain the obtuse angle during consecutive staplings and reduced console time. AL and AS were independent risk factors for disease‐free survival (P = .02) and local recurrence (P = .03), respectively. Conclusions AC were associated with some correctable causes, namely, mechanotechnical errors and lack of use of IFI.

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Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis

Cited by 259 publications

References 43 publications

Fasciocutaneous anterolateral thigh flaps for complex abdominal wall reconstruction after resection of enterocutaneous fistulas and the role of indocyanine green angiography: a pilot study

Fasciocutaneous anterolateral thigh flaps for complex abdominal wall reconstruction after resection of enterocutaneous fistulas and the role of indocyanine green angiography: a pilot study

Recurrence of rectal anastomotic leakage following stoma closure: assessment of risk factors

Mechanotechnical faults and particular issues of anastomotic complications following robot‐assisted anterior resection in 968 rectal cancer patients

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