Anastomotic leak test using indocyanine green during laparoscopic Roux-en-Y gastric bypass: A cohort study. (December 2022)

• Record Type: Journal Article
• Authors: Pavone, Giovanna; Fersini, Alberto; Pacilli, Mario; Cianci, Pasquale; Ambrosi, Antonio; Tartaglia, Nicola
• Is Part Of: Annals of medicine and surgery. Volume 84(2022)
• Publication Date: 2022-12
• Subjects: Laparoscopic Roux-en-Y Gastric Bypass -- Indocyanine green test -- Anastomotic fistula -- Gastro-jejunal leak; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2022.104939
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Background: Indocyanine green (ICG) can be injected into the human bloodstream and it allows us to show stomach vascularity in real time. The aim of our study is to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic Roux-en-Y Gastric Bypass (RYGB in our center and how the perfusion of the gastro-jejunal anastomosis affects the onset of fistula. Materials and methods: 30 consecutive patients underwent RYGB with ICG fluorescence angiography at our center from January 2020 to December 2021.5 ml of ICG were then injected intravenously to identify the blood supply of the stomach and the gastro-jejunal anastomosis. The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05476159 for the Organization UFoggia. Results: In the RYGB tested with ICG, we all have adequate perfusion but despite this a methylene blue test was positive and allowed us to reinforce the suture of the gastro-jejunal anastomosis. Conclusion: Intraoperative ICG testing during laparoscopic RYGB may be helpful in determining which patients are at an increased risk for leakage but multiple factors concur to the pathophysiology and the incidence of gastric fistula not only the perfusion. Highlights: Gastric Bypass is a common operation for weight loss in patients with severe obesity. In regards to Roux-en-Y gastric bypass (RYGB), anastomotic leaks are their most common complications with an incidence of 0–8%. Indocyanine green fluorescence angiography (ICG) is an emerging technology that has been used in an attempt to reduce the incidence of anastomotic leaks.