Intraoperative Indocyanine green testing may identify leak during laparoscopic sleeve gastrectomy
Intraoperative Indocyanine green testing may be helpful in determining which patients are at an increased risk for leakage suggests a recent study published in the BMC Surgery.
Indocyanine green (ICG) when injected intravenously into the bloodstream allows us to show stomach vascularity in real-time. The aim of our study was to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic sleeve gastrectomy (LSG) in our centre and how the perfusion of the staple line of the stomach affects the onset of the fistula.
Obesity is a rising global epidemic that places significant strain on health care services worldwide. Bariatric surgery has become the most effective way to achieve significant weight loss and improve the associated comorbidities of obesity. Obesity is more prevalent in industrialized countries, and its incidence is continually rising.
The pathogenesis of gastric leakage has still not been clarified, even though a multifactorial aetiology (ischaemic, mechanical, inflammatory) has been considered [3,4,5]. Although there are various methods of detecting intraoperative leaks, no standardized algorithm for the intraoperative diagnosis of the gastric leak is available
82 patients underwent LSG with ICG fluorescence angiography at our centre from January 2020 to December 2021. 5 ml of ICG was injected intravenously to identify the blood supply of the stomach, carefully assessing the angle of His.
The Results of the study are:
In the ICG-tested LSG, we recorded adequate perfusion in all patients but one: the leakage rate was 1.2%. This data is inferior to the non-tested patients' group.
Thus, intraoperative ICG testing may be helpful in determining which patients are at an increased risk for leakage but there are multiple factors that contribute to the pathophysiology and the incidence of gastric fistula not only the perfusion.
Reference:
Pavone, G., Fersini, A., Pacilli, M. et al. Can indocyanine green during laparoscopic sleeve gastrectomy be considered a new intraoperative modality for leak testing? BMC Surg 22, 341 (2022). https://doi.org/10.1186/s12893-022-01796-5
