Evaluation of the role of indocyanine green florescence images in the assessment of the perfusion pattern of the anastomotic margins during laparoscopic colorectal surgeries and its impact over intra-operative decisions

Abstract

Background: Anastomotic leakage (AL) is one of the most dreadful complications of colonic resections with a mortality rate of about (12% - 21%). Despite the improvement of laparoscopic systems and anastomotic techniques, the rate of AL is still high (6% - 15%). Poor perfusion at the anastomotic site is a major cause of AL. Indocyanine green fluorescence angiography (ICG-FA) can be used to ensure good perfusion at the resection site to construct a safe anastomosis. Aim of the study: To assess the impact of ICG-FA in changing the surgical site rection on the rates of colorectal anastomotic leak compared to the traditional white light assessment of the resection site. Patients and method: It’s a prospective case-control study that included the patients who underwent successful laparoscopic colectomy during the period from Aug 2020 to Feb 2022. 39 patients were included in the study and were divided into two groups: The ICG-FA group (16 patients) in which we used ICG-FA to assess the perfusion at the resection site to perform the anastomosis. And the Control group (23 patients) in which the perfusion of the anastomotic site was assessed under white light. Results: The assessment of the perfusion using ICG-FA led to changing the surgical plan in two patients (12.5%). The leakage rate was 6.3% (one patient) in the ICG-FA group compared to 8.7% (two patients) in the control group. The decrease in AL was statistically insignificant and we cannot prove that the change in the surgical plan using ICG-FA had reduced the leakage rate because of the small sample size. So, larger prospective, randomized controlled studies are recommended to prove its efficiency.