Rozana H Dwyer, MD, Alyssa Mowrer, Yanzhi Wang, PhD, David L Crawford, MD, Eileen Hou, Steve S Tsoraides, MD. University of Illinois College of Medicine at Peoria
Introduction: Anastomotic leaks are devastating complications of colorectal operations that lead to significant morbidity and potential mortality. Inadequate tissue perfusion is considered a key contributor to anastomotic failure following colorectal operations. Currently, clinical judgment is the most commonly used method for evaluating adequate blood supply to an anastomosis. More recently intraoperative laser angiography using indocyanine green (ICG) has been utilized to assess tissue viability, particularly in reconstructive plastic surgery. This technology provides a real-time evaluation of tissue perfusion and is a helpful tool for intra-operative decisions, particularly in deciding to revise an intended colorectal anastomosis. Our study aimed to determine if there is a statistical significance in colorectal anastomotic leak or abscess rate using ICG compared to common clinical practice.
Methods and Procedures: 126 patients undergoing left-sided colorectal operations, between March 2012 and February 2015, were retrospectively reviewed. 55 patients’ colorectal anastomoses were evaluated using ICG angiography (ICGa) to qualitatively assess tissue perfusion (ICG group). Peri-operative and post-operative outcomes, including anastomotic leak and abscess rates, were compared to 65 patients who had colorectal operations without ICGa (control group). The primary outcomes of intra-abdominal leak rate and intra-abdominal abscess rate were compared using exact Chi-square tests. The secondary outcomes of 30-days OR return, mortality, and readmission rate were compared using Chi-square tests. All statistical analyses were performed using SAS software.
Results: Two leading indications for surgery included malignancy (n=57) and diverticulitis (n=48). The majority of patients either had a low anterior resection (n=75) or sigmoidectomy (n=42). All operations were primarily minimally invasive. No statistically significant difference was seen between the two groups in regards to patient demographics, rate of proximal diversion (p=0.112), and splenic flexure mobilization (p=0.200). Patients in the ICGa group were more likely to have high IMA ligation than in the control group (70.9% vs. 24.4%, p-value <0.001). Of the ICGa group, 16 of the 55 patients underwent additional colonic resection while 39 of the 55 did not undergo additional colonic resection. There was no statistically significant difference in primary or secondary outcomes between the two groups.
Conclusion: ICG angiography has become a helpful adjunct in determining adequate perfusion to an intended colorectal anastomosis. This data is unable to support any difference in patient outcome utilizing this technology over surgeons’ visual and clinical assessment. Our results may contribute to larger studies to determine if there is a true difference in anastomotic leak or abscess rate using this technology.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86879
Program Number: P292
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster