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ROLE OF INDOCYANINE GREEN(ICG) IN REDUCING BILE DUCT INJURIES IN LAPAROSCOPIC CHOLECYSTECTOMY
Ramesh Ardhanari
*, Mohan Narasimhan, Srinivasan Ramachandran, RaviTeja Oleti
GI Surgery and GI Onncology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
Background: Bile Duct Injuries during laparoscopic cholecystectomy is twice as frequent compared to injuries during an open procedure (0.3% open
vs 0.6% laparoscopic). The risk further increases in acute case to upto 4 %. Real time image of Biliary anatomy during Laparoscopic Cholecystectomy lowers the incidence of Bile Duct Injuries by providing better delineation of biliary anatomy .
Methods: The aim of this Retrospective study was to evaluate the feasibility and usefulness of Indocyanine green in intraoperative assessment of biliary anatomy and thus a avoiding bile duct injury . From May 2022 to May 2024, patients admitted to SGE department , MMHRC for Laparoscopic Cholecystectomy were considered. 5 mg ICG injected intravenously one hour before the procedure, and the biliary anatomy was assessed using fluorescence camera system prior to clipping the cystic duct. Primary outcome was Incidence of Bile Duct Injuries .
Results: Our analysis included 976 patients . Of them Acute Cholecystitis - 252 , Chronic Cholecystitis - 40 , Empyema - 54, Gangrenous - 47 , Acute Pancreatitis - 83 , SGSD - 443 , Mucocele - 40 , Mirizzi Syndrome - 3 , Polyp 8 , Emphysematous 1 , Post partial chole - 1 , Acalculous Cholecystitis - 2 , Mirizzi Syndrome with Choledocho cutaneous fistula - 1 .
Visible fluorescence was detected in 100% of the cases. Total 4 patients had Bile duct injury.
Injuries classified as per Strassberg - Bismuth Classification
Type A injury seen in A case of Gangrenous Cholecystitis
Type D injury seen in two cases - One was Symptomatic gall stone disease and other was a case of Acute Cholecystitis
Type E2 injury seen in A case of Symptomatic gall stone disease
Patients with Type A and Type D injuries were managed conservatively
Type E2 Injury was later operated with Roux en Y HepaticoJejunostomy.
The overall bile duct injury rate is 0.18% in case of simple gall bladder surgery(symptomatic gall stones,polyps) where as in cases of difficult gall bladder surgery(acute cholecystitis and gangrenous cholecystitis,Mirizzi syndrome etc) the incidence is 0.6 % way less than 1.89 % as described in literature.
Conclusion: Indocyanine green immunofluoroscence shows promising results as a safe and feasible tool to prevent bile duct injury during Laparoscopic Cholecystectomy.
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