Intraoperative Evaluation of the Gastric Conduit Perfusion with Indocyanine Green Fluorescein Imaging and Correlation with Anastomotic Leakage after Esophagectomy

Mahmoodzadeh H, Farahzadi A, Ramesh O, Harirchi I, Shirkhoda M, Jalayifar AM and Miri R

Department of General Surgery, Tehran University of Medical Sciences, Cancer Institute, Iran Breast Disease Research Center, Tehran University of Medical Sciences, Iran

^*Correspondance to: Athena Farahzadi 

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Abstract:

Aim: Anastomotic Leakage (AL) remains a major cause of postoperative morbidity and mortality in gastrointestinal reconstructive surgery. Insufficient local blood supply is an important risk factor for AL. Indocyanine Green (ICG) fluorescence can visualize gastric blood flow and determine if it is sufficient for anastomosis. We evaluated gastric conduit perfusion and the need to change the anastomotic site based on ICG mapping and compared the postoperative leak rate with a historical control group. Methods: 2.5 mg of ICG was injected intravenously. Adequate perfusion was defined as clear visualization of fluorescence around the gastric tube at an estimated 15 sec to 60 sec after intravenous administration. Results: The mean age of patients was 56.44 (SD:10.37) in the ICG group and 56.39 (SD:7.89) in the non-ICG group. The mean operative time was 366.67 min (SD:82.67) and 403.89 min (SD:71.01) in ICG and non-ICG groups, respectively. They were not significantly different. No adverse reactions or allergies to ICG were detected. The Mean extra time for ICG injection was 3 min (SD:3.88). The injection dose of ICG was 2.5 mg. In the ICG group, no patient suffered from anastomotic leakage. Two patients in the non-ICG group developed symptomatic AL after surgery. According to Fisher's exact test, there was no significant association between AL development and ICG use, possibly due to the small sample size. In three cases, the site of anastomosis was changed after ICG perfusion mapping.
Conclusion: We found that intraoperative ICG-FA is a useful adjunct in assessing gastric tube perfusion and reduces the risk of postoperative AL.

Keywords:

Anastomotic leakage; Esophageal cancer; Gastric conduit perfusion; Indocyanine green fluorescein imaging

Cite the Article:

Mahmoodzadeh H, Farahzadi A, Ramesh O, Harirchi I, Shirkhoda M, Jalayifar AM, et al. Intraoperative Evaluation of the Gastric Conduit Perfusion with Indocyanine Green Fluorescein Imaging and Correlation with Anastomotic Leakage after Esophagectomy. World J Surg Surgical Res. 2023; 6: 1472..