Indocyanine Green Fluorescent Angiography During Laparoscopic Sleeve Gastrectomy: Preliminary Results

• Published in: Obesity surgery 2019-12, Vol.29 (12), p.3786-3790
• Main Authors: Di Furia, Marino, Romano, Lucia, Salvatorelli, Andrea, Brandolin, Denise, Lomanto, Davide, Cianca, Giovanni, Schietroma, Mario, Carlei, Francesco, Giuliani, Antonio
• Format: Article
• Language: English
• Subjects: Adult; Anastomotic Leak - diagnosis; Anastomotic Leak - etiology; Anastomotic Leak - therapy; Angiography - methods; Coloring Agents - pharmacology; Female; Fluorescein Angiography - methods; Gastrectomy - adverse effects; Gastrectomy - methods; Gastrointestinal surgery; Humans; Indocyanine Green - pharmacology; Intraoperative Complications - diagnosis; Intraoperative Complications - etiology; Intraoperative Complications - therapy; Italy; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Obesity; Obesity, Morbid - pathology; Obesity, Morbid - surgery; Original Contributions; Preliminary Data; Stomach - drug effects; Stomach - pathology; Stomach - surgery; Surgery; Tomography, X-Ray Computed
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-019-04085-y

Introduction Indocyanine green (ICG) fluorescent angiography has been routinely applied for various laparoscopic procedures to evaluate the tissue blood supply. A promising branch for this technology is represented by bariatric surgery, especially to estimate the risk of gastric leak after laparoscopic sleeve gastrectomy (LSG), which seems mainly related to ischemia of the stomach. Materials and Methods 43 consecutive patients from January 2018 to March 2019 underwent in our institution LSG with intravenous injection of 5 ml ICG after the realization of gastric tube to evaluate the blood supply of the gastric tube. Results In all 43 cases, there have been no adverse events related to ICG. The vascular supply to stomach was estimated “satisfactory” along the stapled line in all cases. However, one patient showed signs and symptoms indicative of gastric leak in the fifth post-op day and diagnosis was confirmed by CT scan with Gastrografin. Conclusions From our preliminary data, the intraoperative view of the blood supply of the stomach does not seem to represent a prognostic factor for the risk of gastric leak, suggesting a complex multifactorial etiology (intragastric hypertension? Abnormal inflammatory response?) which needs further data to be established.