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      The Use of Fluorescence Angiography During Laparoscopic Sleeve Gastrectomy.

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          Abstract

          A new technology involving indocyanine green (ICG) fluorescence angiography has been introduced to assess tissue perfusion and perform vascular mapping during laparoscopic surgery. The purpose of this study was to describe the use of this technology to identify the variable blood supply patterns to the stomach and gastroesophageal (GE) junction during laparoscopic sleeve gastrectomy (LSG), which may help in preserving the blood supply and preventing ischemia-related leaks.

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          Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study.

          Mehraneh D Jafari, Steven D. Wexner, Joseph E. Martz … (2015)
          Our primary objective was to demonstrate the utility and feasibility of the intraoperative assessment of colon and rectal perfusion using fluorescence angiography (FA) during left-sided colectomy and anterior resection. Anastomotic leak (AL) after colorectal resection increases morbidity, mortality, and, in cancer cases, recurrence rates. Inadequate perfusion may contribute to AL. The PINPOINT Endoscopic Fluorescence Imaging System allows for intraoperative assessment of anastomotic perfusion.
          Article 0 comments Cited 150 times – based on 0 reviews     Review now
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            Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients.

            Ahmad Mahajna, A Raziel, Nasser Sakran … (2012)
            Laparoscopic sleeve gastrectomy (LSG) remains under scrutiny as a stand-alone bariatric procedure. The most feared complication after LSG is staple line leak. Eight bariatric centers in Israel participated in this study. A retrospective analysis was performed by querying all the LSG cases performed between June 2006 and June 2010. The data collected included patient demographics, anthropometrics, and operative and perioperative parameters. Among the 2,834 patients who underwent LSG, 44 (1.5%) with gastric leaks were identified. Of these 44 patients, 30 (68%) were women. The patients had a mean age of 41.5 years and a body mass index (BMI) of 45.4 kg/m(2). Intraoperative leak tests and routine postoperative swallow studies were performed with 33 patients, and all but one patient (3%) failed to detect the leaks. Leaks were diagnosed at a median of 7 days postoperatively: early (0-2 days) in nine cases (20%), intermediately (3-14 days) in 32 cases (73%), and late (>14 days) in three cases (7%). For 38 patients (86%), there was clinical suspicion, later confirmed by imaging or operative findings. Computed tomography, swallow studies, and methylene blue tests were performed for 37, 21, and 15 patients, respectively, and the results were positive, respectively, for 31 (84%), 11 (50%), and 9 (60%) of these patients. Reoperation was performed for 27 of the patients (61%). Other treatment methods included percutaneous drainage (n = 28, 63.6%), endoscopic placement of stents (n = 11, 25%), clips (n = 1, 2.3%), and fibrin glue (n = 1, 2.3%). In 33 of the patients (75%), the leak site was found in the upper sleeve near the gastroesophageal junction. The median time to leak closure was 40 days (range, 2-270 days), and the overall leak-related mortality rate was 0.14% (4/2,834). Gastric leak is the most common cause of major morbidity and mortality after LSG. Routine tests to rule out leaks seem to be superfluous. Rather, selective utilization is recommended. Management options vary, depending mainly on patient disposition. An accepted algorithm for the diagnosis and treatment of gastric leak has yet to be proposed.
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              Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study.

              Stefano Rausei, Alessandro Marzorati, Gianlorenzo Dionigi … (2017)
              Colorectal anastomoses after anterior resection for cancer carry a high risk of leakage. Different factors might influence the correct healing of anastomosis, but adequate perfusion of the bowel is highlighted as one of the most important elements. Fluorescence angiography (FA) is a new technique that allows the surgeon to perform real-time intraoperative angiography to evaluate the perfusion of the anastomosis and hence, potentially, reduce leak rate.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): JSLS
                Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Publisher: The Society of Laparoscopic and Robotic Surgeons
                ISSN (Electronic): 1938-3797
                ISSN (Print): 1086-8089
                Publication date (Electronic): 2018
                Volume: 22
                Issue: 2
                Affiliations
                [1 ] Department of Surgery, Duke University Health System, Durham, North Carolina, USA.
                Article
                Publisher Item ID: JSLS.2018.00005
                DOI: 10.4293/JSLS.2018.00005
                PMC ID: 6016860
                PubMed ID: 29950800
                SO-VID: bc9a7d47-3046-44d8-944e-ef4f83f23587
                History

                Keywords: Bariatric surgery,Fluorescence angiography,Laparoscopic sleeve gastrectomy,Leaks,Obesity
                Data availability:
                Keywords: Bariatric surgery, Fluorescence angiography, Laparoscopic sleeve gastrectomy, Leaks, Obesity

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