Indocyanine Green Fluorescent Angiography During Laparoscopic Sleeve Gastrectomy: Preliminary Results
- 18 Downloads
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.
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.
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.
KeywordsSleeve Gastrectomy Indocyanine green fluorescent angiography Obesity Gastric leakage
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Ogden CL, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2011–2014: National Center for Health Statistics data brief; 2015. p. 29.Google Scholar
- 7.Marchese M, Romano L, Giuliani A, et al. Corrigendum to “A case of intrasplenic displacement of an endoscopic double-pigtail stent as a treatment for laparoscopic sleeve gastrectomy leak” [Int. J. Surg. Case Rep. 53 (2018) 367–369]. Int J Surg Case Rep. 2019;56:49. https://doi.org/10.1016/j.ijscr.2019.02.027.CrossRefGoogle Scholar
- 8.Giuliani A, Romano L, Marchese M, et al. Gastric leak after laparoscopic sleeve gastrectomy: management with endoscopic double pigtail drainage. A systematic review. Surg Obes Relat Dis. 2019; pii: S1550-7289(19)30087-5. https://doi.org/10.1016/j.soard.2019.03.019. [Epub ahead of print]
- 17.Kim J, Azagury D, Eisenberg D, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11(4):739–48. https://doi.org/10.1016/j.soard.2015.05.001.CrossRefGoogle Scholar
- 28.Aggarwal S, Bhattacharjee H, Chander Misra M. Practice of routine intraoperative leak test during laparoscopic sleeve gastrectomy should not be discarded. Surg Obes Relat Dis. 2011;7(5):e24–5.Google Scholar
- 29.Frattini F, Lavazza M, Mangano A, et al. Indocyanine green-enhanced fluorescence in laparoscopic sleeve gastrectomy. Obes Surg. 2015;25(5):949–50. https://doi.org/10.1007/s11695-015-1640-8.