THE USE OF FLUORESCENCE ANGIOGRPAHY TO ASSESS BOWEL VIABILITY IN THE ACUTE SETTING: AN INTERNATIONAL, MULTI-CENTRE EXPERIENCE
Hanneke Joosten*1, Roel Hompes1, Frederic Ris2, Ronan Cahill3, Willem A. Bemelman1
1Surgery, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, Netherlands; 2Hopitaux universitaires de Geneve Departement des specialites de medecine, Geneve, GE, Switzerland; 3Mater Misericordiae University Hospital, Dublin, Ireland
Introduction: Assessing bowel viability can be challenging during acute surgical procedures, especially when it comes to mesenteric ischaemia. Intraoperative fluorescence angiography (FA) may be a valuable tool for the surgeon to determine whether bowel resection is necessary, and to define the most appropriate resection margins. The aim of this study is to report on the use of FA in the acute setting and to judge its impact on intraoperative decision making.
Materials and methods: This is a multi-centre, retrospective cohort study of patients that underwent FA-guided emergency abdominal surgery between February 2016 and February 2021 in three colorectal units where intraoperative FA was performed to assess bowel viability. Primary endpoint was change of management in surgical strategy after the FA assessment.
Results: A total of 93 patients (50 males, 66.6 ± 19.2 years, ASA score >III in 85%) were operated on in the acute setting. Surgical approach was laparotomy in 66 (71%) patients and laparoscopy in 27 (29%) of which seven (25%) were converted. The most common aetiologies were mesenteric ischaemia (n=42,45%) and adhesional/herniae-related strangulation (n=41, 44%). In 50 patients a bowel resection was done. Overall rates of anastomosis after resection, reoperation and 30-day mortality were 48% (24/50, one leak), 12% and 18% respectively. FA changed management in 27 (29%) patients. In four patients, resection was avoided and in 21 (23% overall) extra bowel length was preserved (median 50 cm of bowel saved, IQR 28-98) although three patients developed further ischaemia. In six (5%) patients an extended resection (median of 20cm, IQR 6-50 extra bowel) was prompted.
Conclusion: In patients operated for bowel ischaemia the intraoperative use of FA preserved bowel in approximately one out of four patients but care is needed in its interpretation. These preliminary results warrant further prospective studies of this promising technology.
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