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ROLE OF INDOCYANINE GREEN IN EVALUATING VASCULARITY OF BOWEL ENDS PRIOR TO ANASTOMOSIS IN COLORECTAL OPERATIONS
Ramesh Ardhanari
*, Mohan Narasimhan, Srinivasan Ramachandran, RaviTeja Oleti
GI Surgery and GI Onncology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
Background: Anastomotic leakage is one of the most feared postoperative complications in colorectal surgery and poor vascular perfusion of bowel is one of the causes . Indocyanine green helps identify the bowel vascularity in real time.
Methods: The aim of this prospective study was to evaluate the usefulness of Indocyanine green in intraoperative assessment of vascular perfusion of the anastomosis .From May 2022 to February 2024, patients admitted to SGE department , MMHRC for surgeries involving colonic anastomosis both elective and emergency were considered. 7.5 mg ICG injected intravenously, and the bowel perfusion was assessed using fluorescence camera system prior to anastomosis. The perfusion was considered good if the cut end of colon was seen to show fluorescence at same time as adjacent loop of small bowel. Primary outcomes were intraoperative change in the surgical resection margin due to inadequate vascularization and anastomotic leaks .
Results: 112 consecutive patients : 32 right colectomies, 26 colostomy reversals, 1 splenic flexure segmental resection, 6 left colectomies, 5 subtotal colectomies and 42 anterior resections were analysed . In 65 % of cases, the indication for surgery was malignancy .Visible fluorescence was detected in 100% of the cases. In 10(8.9%) patients , the planned site of resection was changed to a more proximal site due to inadequate perfusion. The mean extension of the surgical resection in these 10 patients was 2 ± 0.5 cm.
Anastomotic leakage occurred in 3 patients (2.6%) who had 100% fluoroscence intraoperatively . Two patients with leak were reoperated and anastomosis taken down and end colostomy done.Te patients recovered well The third patient had a controlled leak which spontaneously settled. Other complications included pulmonary thromboembolism in 2 patients, SSI in 4 patients . The overall morbidity rate was 8 %. There was no mortality in the group.
Conclusion: Indocyanine green immunofluoroscence helps in assessing vascularity and reduces leakage from our own past results of 7.1% and literature average of 5%. It is a safe and rapid tool to assess bowel perfusion during an open or laparoscopic surgery for colonic resection and may reduce the post operative leakage.
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