Vascular Perfusion in Small Bowel Anastomosis
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The perfusion of the resected ends of the bowel is of vital importance for the proper healing of an anastomosis. However, the perfusion assessment of the anastomotic ends is often imprecise and subjective. The assessment of perfusion of the bowel is also paramount in cases of emergent operations for ischemia. In these cases, the extent of resection is dependent on the accurate assessment of vitality of the intestine left behind. When doubts exist, second-look laparotomies are necessary to ensure that all the bowels left behind remain viable. Therefore, any modality that can provide an objective assessment of perfusion at the bowel ends can reduce the risk of postoperative anastomosis dehiscence and strictures.
Although modalities like color of the serosal surface, presence of bowel peristalsis, pulsation and bleeding from the marginal arteries, and Doppler have been studied in the past, their accuracy remains variable and somewhat subjective. More recently, fluorescent imaging with indocyanine green (ICG) has shown to objectively identify the potentially ischemic bowel tissue, thereby reducing the rates of failure of anastomosis. Quantitative assessment of the fluorescent perfusion is currently being developed as well.
KeywordsVascular perfusion Indocyanine green Bowel anastomosis Fluorescent angiography Bowel incarceration Bowel ischemia
Observation and evaluation of perfusion of the bowel with ICG angiography to establish viability (MOV 168040 kb)
- 5.Ryu S, Yoshida M, Ohdaira H, Tsutsui N, Suzuki N, Ito E, Nakajima K, Yanagisawa S, Kitajima M, Suzuki Y. Intestinal blood flow assessment by indocyanine green fluorescence imaging in a patient with the incarcerated umbilical hernia: report of a case. Ann Med Surg (Lond). 2016;8:40–2.CrossRefGoogle Scholar
- 9.Iinuma Y, Hirayama Y, Yokoyama N, Otani T, Nitta K, Hashidate H, Yoshida M, Iida H, Masui D, Manabe S. Intraoperative near-infrared indocyanine green fluorescence angiography (NIR-ICG AG) can predict delayed small bowel stricture after ischemic intestinal injury: report of a case. J Pediatr Surg. 2013;48:1123–8.CrossRefGoogle Scholar
- 12.Menzo EL, Lo Menzo E, Dip FD, Szomstein S, Rosenthal RJ. Economic impact of fluorescent cholangiography. In: Fluorescence imaging for surgeons. UK: Springer; 2015. p. 99–106.Google Scholar
- 17.Diana M, Agnus V, Halvax P, Liu YY, Dallemagne B, Schlagowski AI, Geny B, Diemunsch P, Lindner V, Marescaux J. Intraoperative fluorescence-based enhanced reality laparoscopic real-time imaging to assess bowel perfusion at the anastomotic site in an experimental model. Br J Surg. 2015;102:e169–76.CrossRefGoogle Scholar