Can indocyanine green during laparoscopic sleeve gastrectomy be considered a new intraoperative modality for leak testing?

• Published in: BMC surgery Vol. 22; no. 1; pp. 341 - 5
• Main Authors: Pavone, Giovanna, Fersini, Alberto, Pacilli, Mario, De Fazio, Michele, Panzera, Piercarmine, Ambrosi, Antonio, Tartaglia, Nicola
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.09.2022; BioMed Central; BMC
• Subjects: Angiography; Endoscopy; Fistula; Fistulae; Fluorescence; Gastrectomy; Gastrectomy - methods; Gastric fistula; Gastrointestinal surgery; Humans; Hypertension; Indocyanine Green; Indocyanine green test; Insulin-like growth factors; Ischemia; Laparoscopic sleeve gastrectomy; Laparoscopic surgery; Laparoscopy; Laparoscopy - methods; Leak testing; Leakage; Medical imaging; Obesity; Patients; Perfusion; Retrospective Studies; Stomach; Stomach - surgery; Weight control; Indocyanine green test; Laparoscopic sleeve gastrectomy; Gastric fistula
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-022-01796-5

Indocyanine green (ICG) when injected intravenously into the bloodstream allows us to show stomach vascularity in real time. The aim of our study was to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic sleeve gastrectomy (LSG) in our center and how the perfusion of the staple line of the stomach affects the onset of fistula. 82 patients underwent LSG with ICG fluorescence angiography at our center from January 2020 to December 2021. 5 ml of ICG was injected intravenously to identify the blood supply of the stomach, carefully assessing the angle of His. In the ICG-tested LSG, we recorded adequate perfusion in all patients but one: the leakage rate was 1.2%. This data is inferior to the non-tested patients' group. Intraoperative ICG testing may be helpful in determining which patients are at an increased risk for leakage but there are multiple factors contribute to the pathophysiology and the incidence of gastric fistula not only the perfusion. Trial registration Retrospectively registrated.