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The Use of Near-Infrared Fluorescence in Sleeve Gastrectomy

  • Leonard K. Welsh
  • Jin S. Yoo
  • A. Daniel GuerronEmail author
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Abstract

Obesity is the most prevalent chronic disease in the United States and bariatric surgery stands as the best treatment. Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric operation performed in the United States. Leaks after LSG are rare but represent the most serious complication. The majority of leaks occur in the proximal third of the stomach near the angle of His, and ischemia is the most likely etiology. Indocyanine green (ICG) is an ideal compound to assess tissue perfusion intraoperatively, and ICG fluorescence angiography during LSG can be used to identify blood supply patterns. Confirming adequate perfusion of the remnant sleeve stomach minimizes perfusion compromise and prevents potential serious postoperative complications including leaks and strictures. ICG can also be used in anastomotic operations such as gastric bypass and biliopancreatic diversion with duodenal switch with many potential future applications.

Keywords

Bariatric surgery Sleeve gastrectomy Indocyanine green Fluorescent imaging Leak prevention 

Supplementary material

Video 10.1

Near-infrared fluorescence in laparoscopic sleeve gastrectomy. An initial dose of 1–2 mL of indocyanine green solution dose is given and cardiac enhancement (first red arrow) should be seen followed by enhancement of the left inferior phrenic artery (second red arrow). The gastrohepatic ligament is inspected for accessory arteries (red circle). Sleeve construction is performed with care to not injure the identified inferior phrenic artery (red arrow). A repeat dose of 3–5 mL of solution is given to verify artery preservation (red arrow). Right-side dominant variant: the left gastric is seen enhancing first (red circle) briefly followed by the left inferior phrenic artery (red arrow) (MP4 657578 kb)

References

  1. 1.
    Ogden CL, Carroll MD, Fakhouri TH, Hales CM, Fryar CD, Li X, et al. Prevalence of obesity among youths by household income and education level of head of household - United States 2011–2014. MMWR Morb Mortal Wkly Rep. 2018;67(6):186–9.  https://doi.org/10.15585/mmwr.mm6706a3.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS data brief. 2017;(288):1–8.Google Scholar
  3. 3.
    Currie A, Chetwood A, Ahmed AR. Bariatric surgery and renal function. Obes Surg. 2011;21(4):528–39.  https://doi.org/10.1007/s11695-011-0356-7.CrossRefPubMedGoogle Scholar
  4. 4.
    Nostedt JJ, Switzer NJ, Gill RS, Dang J, Birch DW, de Gara C, et al. The effect of bariatric surgery on the spectrum of fatty liver disease. Can J Gastroenterol Hepatol. 2016;2016:2059245.  https://doi.org/10.1155/2016/2059245.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Sarkhosh K, Switzer NJ, El-Hadi M, Birch DW, Shi X, Karmali S. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg. 2013;23(3):414–23.  https://doi.org/10.1007/s11695-012-0862-2.CrossRefPubMedGoogle Scholar
  6. 6.
    Tan O, Carr BR. The impact of bariatric surgery on obesity-related infertility and in vitro fertilization outcomes. Semin Reprod Med. 2012;30(6):517–28.  https://doi.org/10.1055/s-0032-1328880.CrossRefPubMedGoogle Scholar
  7. 7.
    Yska JP, van Roon EN, de Boer A, Leufkens HG, Wilffert B, de Heide LJ, et al. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery: a population-based cohort study in the United Kingdom. JAMA Surg. 2015;150(12):1126–33.  https://doi.org/10.1001/jamasurg.2015.2398.CrossRefPubMedGoogle Scholar
  8. 8.
    Angrisani L, Santonicola A, Vitiello A, Iovino P. Reply to letter to the editor: bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2018;28(1):251–2. United States.CrossRefGoogle Scholar
  9. 9.
    Altieri MS, Yang J, Groves D, Obeid N, Park J, Talamini M, et al. Sleeve Gastrectomy: the first 3 years: evaluation of emergency department visits, readmissions, and reoperations for 14,080 patients in New York State. Surg Endosc. 2018;32(3):1209–14.  https://doi.org/10.1007/s00464-017-5793-5.CrossRefPubMedGoogle Scholar
  10. 10.
    Guerron AD, Ortega CB, Portenier D. Endoscopic abscess septotomy for management of sleeve gastrectomy leak. Obes Surg. 2017;10. United States.:2672–4.CrossRefGoogle Scholar
  11. 11.
    Aminian A, Brethauer SA, Sharafkhah M, Schauer PR. Development of a sleeve gastrectomy risk calculator. Surg Obes Relat Dis. 2015;11(4):758–64.  https://doi.org/10.1016/j.soard.2014.12.012.CrossRefPubMedGoogle Scholar
  12. 12.
    Takahashi H, Strong AT, Guerron AD, Rodriguez JH, Kroh M. An Odyssey of complications from band, to sleeve, to bypass; definitive laparoscopic completion gastrectomy with distal esophagectomy and esophagojejunostomy for persistent leak. Surg Endosc. 2018;32(1):507–10.  https://doi.org/10.1007/s00464-017-5757-9.CrossRefPubMedGoogle Scholar
  13. 13.
    Ortega CB, Guerron AD, Portenier D. Endoscopic abscess septotomy: a less invasive approach for the treatment of sleeve gastrectomy leaks. J Laparoendosc Adv Surg Tech A. 2018;28(7):859–63.  https://doi.org/10.1089/lap.2017.0429.CrossRefPubMedGoogle Scholar
  14. 14.
    Galloro G, Ruggiero S, Russo T, Telesca DA, Musella M, Milone M, et al. Staple-line leak after sleve gastrectomy in obese patients: a hot topic in bariatric surgery. World J Gastrointest Endosc. 2015;7(9):843–6.  https://doi.org/10.4253/wjge.v7.i9.843.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20(38):13904–10.  https://doi.org/10.3748/wjg.v20.i38.13904.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.  https://doi.org/10.1007/s00464-012-2426-x.CrossRefPubMedGoogle Scholar
  17. 17.
    Delko T, Hoffmann H, Kraljevic M, Droeser RA, Rothwell L, Oertli D, et al. Intraoperative patterns of gastric microperfusion during laparoscopic sleeve gastrectomy. Obes Surg. 2017;27(4):926–32.  https://doi.org/10.1007/s11695-016-2386-7.CrossRefPubMedGoogle Scholar
  18. 18.
    Perez M, Brunaud L, Kedaifa S, Guillotin C, Gerardin A, Quilliot D, et al. Does anatomy explain the origin of a leak after sleeve gastrectomy? Obes Surg. 2014;24(10):1717–23.  https://doi.org/10.1007/s11695-014-1256-4.CrossRefPubMedGoogle Scholar
  19. 19.
    Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Color Dis. 2009;24(5):569–76.  https://doi.org/10.1007/s00384-009-0658-6.CrossRefGoogle Scholar
  20. 20.
    Betz CS, Zhorzel S, Schachenmayr H, Stepp H, Matthias C, Hopper C, et al. Endoscopic assessment of free flap perfusion in the upper aerodigestive tract using indocyanine green: a pilot study. J Plast Reconstr Aesthet Surg. 2013;66(5):667–74.  https://doi.org/10.1016/j.bjps.2012.12.034.CrossRefPubMedGoogle Scholar
  21. 21.
    Boni L, Fingerhut A, Marzorati A, Rausei S, Dionigi G, Cassinotti E. Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc. 2017;31(4):1836–40.  https://doi.org/10.1007/s00464-016-5181-6.CrossRefGoogle Scholar
  22. 22.
    Jafari MD, Lee KH, Halabi WJ, Mills SD, Carmichael JC, Stamos MJ, et al. The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc. 2013;27(8):3003–8.  https://doi.org/10.1007/s00464-013-2832-8.CrossRefPubMedGoogle Scholar
  23. 23.
    Hellan M, Spinoglio G, Pigazzi A, Lagares-Garcia JA. The influence of fluorescence imaging on the location of bowel transection during robotic left-sided colorectal surgery. Surg Endosc. 2014;28(5):1695–702.  https://doi.org/10.1007/s00464-013-3377-6.CrossRefPubMedGoogle Scholar
  24. 24.
    Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, et al. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg. 2015;220(1):82–92.e1.  https://doi.org/10.1016/j.jamcollsurg.2014.09.015.CrossRefGoogle Scholar
  25. 25.
    Kawada K, Hasegawa S, Wada T, Takahashi R, Hisamori S, Hida K, et al. Evaluation of intestinal perfusion by ICG fluorescence imaging in laparoscopic colorectal surgery with DST anastomosis. Surg Endosc. 2017;31(3):1061–9.  https://doi.org/10.1007/s00464-016-5064-x.CrossRefPubMedGoogle Scholar
  26. 26.
    Hutteman M, van der Vorst JR, Mieog JS, Bonsing BA, Hartgrink HH, Kuppen PJ, et al. Near-infrared fluorescence imaging in patients undergoing pancreaticoduodenectomy. Eur Surg Res. 2011;47(2):90–7.  https://doi.org/10.1159/000329411.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Shimada Y, Okumura T, Nagata T, Sawada S, Matsui K, Hori R, et al. Usefulness of blood supply visualization by indocyanine green fluorescence for reconstruction during esophagectomy. Esophagus. 2011;8(4):259–66.  https://doi.org/10.1007/s10388-011-0291-7.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Nachiappan S, Askari A, Currie A, Kennedy RH, Faiz O. Intraoperative assessment of colorectal anastomotic integrity: a systematic review. Surg Endosc. 2014;28(9):2513–30.  https://doi.org/10.1007/s00464-014-3520-z.CrossRefPubMedGoogle Scholar
  29. 29.
    Degett TH, Andersen HS, Gogenur I. Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbeck’s Arch Surg. 2016;401(6):767–75.  https://doi.org/10.1007/s00423-016-1400-9.CrossRefGoogle Scholar
  30. 30.
    Holm C, Tegeler J, Mayr M, Becker A, Pfeiffer UJ, Muhlbauer W. Monitoring free flaps using laser-induced fluorescence of indocyanine green: a preliminary experience. Microsurgery. 2002;22(7):278–87.  https://doi.org/10.1002/micr.10052.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Rodriguez-Hernandez A, Lawton MT. Flash fluorescence with indocyanine green videoangiography to identify the recipient artery for bypass with distal middle cerebral artery aneurysms: operative technique. Neurosurgery. 2012;70(2 Suppl Operative):209–20.  https://doi.org/10.1227/NEU.0b013e31823158f3.CrossRefPubMedGoogle Scholar
  32. 32.
    De Gasperi A, Mazza E, Prosperi M. Indocyanine green kinetics to assess liver function: ready for a clinical dynamic assessment in major liver surgery? World J Hepatol. 2016;8(7):355–67.  https://doi.org/10.4254/wjh.v8.i7.355.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Vos JJ, Wietasch JK, Absalom AR, Hendriks HG, Scheeren TW. Green light for liver function monitoring using indocyanine green? An overview of current clinical applications. Anaesthesia. 2014;69(12):1364–76.  https://doi.org/10.1111/anae.12755.CrossRefPubMedGoogle Scholar
  34. 34.
    Zehetner J, DeMeester SR, Alicuben ET, Oh DS, Lipham JC, Hagen JA, et al. Intraoperative assessment of perfusion of the gastric graft and correlation with anastomotic leaks after esophagectomy. Ann Surg. 2015;262(1):74–8.  https://doi.org/10.1097/sla.0000000000000811.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Ortega CB, Guerron AD, Yoo JS. The use of fluorescence angiography during laparoscopic sleeve gastrectomy. JSLS. 2018;22(2).  https://doi.org/10.4293/jsls.2018.00005.
  36. 36.
    NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956–61.Google Scholar
  37. 37.
    Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring, Md). 2013;21 Suppl 1:S1–27.  https://doi.org/10.1002/oby.20461.CrossRefGoogle Scholar
  38. 38.
    Rosenthal RJ, Diaz AA, Arvidsson D, Baker RS, Basso N, Bellanger D, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.  https://doi.org/10.1016/j.soard.2011.10.019.CrossRefPubMedGoogle Scholar
  39. 39.
    Borbely Y, Juilland O, Altmeier J, Kroll D, Nett PC. Perioperative outcome of laparoscopic sleeve gastrectomy for high-risk patients. Surg Obes Relat Dis. 2017;13(2):155–60.  https://doi.org/10.1016/j.soard.2016.08.492.CrossRefPubMedGoogle Scholar
  40. 40.
    Gagner M. Is sleeve gastrectomy always an absolute contraindication in patients with Barrett’s? Obes Surg. 2016;26(4):715–7.  https://doi.org/10.1007/s11695-015-1983-1.CrossRefPubMedGoogle Scholar
  41. 41.
    Rebecchi F, Allaix ME, Giaccone C, Ugliono E, Scozzari G, Morino M. Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg. 2014;260(5):909–14; discussion 14–5.  https://doi.org/10.1097/sla.0000000000000967.CrossRefGoogle Scholar
  42. 42.
    Alexandrou A, Felekouras E, Giannopoulos A, Tsigris C, Diamantis T. What is the actual fate of super-morbid-obese patients who undergo laparoscopic sleeve gastrectomy as the first step of a two-stage weight-reduction operative strategy? Obes Surg. 2012;22(10):1623–8.  https://doi.org/10.1007/s11695-012-0718-9.CrossRefPubMedGoogle Scholar
  43. 43.
    Sanchez-Pernaute A, Rubio MA, Conde M, Arrue E, Perez-Aguirre E, Torres A. Single-anastomosis duodenoileal bypass as a second step after sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(2):351–5.  https://doi.org/10.1016/j.soard.2014.06.016.CrossRefPubMedGoogle Scholar
  44. 44.
    Biertho L, Theriault C, Bouvet L, Marceau S, Hould FS, Lebel S, et al. Second-stage duodenal switch for sleeve gastrectomy failure: a matched controlled trial. Surg Obes Relat Dis. 2018;14(10):1570–9.  https://doi.org/10.1016/j.soard.2018.05.008.CrossRefPubMedGoogle Scholar
  45. 45.
    Panagouli E, Venieratos D, Lolis E, Skandalakis P. Variations in the anatomy of the celiac trunk: a systematic review and clinical implications. Ann Anat. 2013;195(6):501–11.  https://doi.org/10.1016/j.aanat.2013.06.003.CrossRefPubMedGoogle Scholar
  46. 46.
    Loukas M, Hullett J, Wagner T. Clinical anatomy of the inferior phrenic artery. Clin Anat. 2005;18(5):357–65.  https://doi.org/10.1002/ca.20112.CrossRefPubMedGoogle Scholar
  47. 47.
    Tomosugi T, Takahashi T, Kawase Y, Yoshida K, Hayashi S, Sugiyama T, et al. Accessory left gastric artery aneurysms in granulomatosis with polyangiitis: a case report and literature review. Nagoya J Med Sci. 2017;79(1):75–83.  https://doi.org/10.18999/nagjms.79.1.75.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Boules M, Corcelles R, Guerron AD, Dong M, Daigle CR, El-Hayek K, et al. The incidence of hiatal hernia and technical feasibility of repair during bariatric surgery. Surgery. 2015;158(4):911–6; discussion 6–8.  https://doi.org/10.1016/j.surg.2015.06.036.CrossRefPubMedGoogle Scholar
  49. 49.
    Saber AA, Azar N, Dekal M, Abdelbaki TN. Computed tomographic scan mapping of gastric wall perfusion and clinical implications. Am J Surg. 2015;209(6):999–1006.  https://doi.org/10.1016/j.amjsurg.2014.05.023.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Leonard K. Welsh
    • 1
  • Jin S. Yoo
    • 1
  • A. Daniel Guerron
    • 1
    Email author
  1. 1.Department of Surgery, Division of Metabolic and Weight Loss SurgeryDuke UniversityDurhamUSA

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