Mohammed M Al-Abri, MD, Noura Alhassan, MD, Patrick Charlebois, MD, A. Sender Liberman, MD, Gerald Fried, MD, Berry L Stein, MD, Carmen Mueller, MD, Liane Feldman, MD, Pepa Kanava, Msc, Lawrence Lee, MD, PHD. McGill University Health Centre
Background: Immunofluorescence angiography (IFA) with indocyanine green (ICG) can be useful to assess anastomotic perfusion in high risk bowel surgery, and may help reduce the risk of leak. However, the indications for its use are unclear. Past studies have not demonstrated a high proportion of patients in which management was altered, however these studies described its use in unselected patients. Perfusion assessment with IFA may be most beneficial in high-risk patients. The objective of this study was to evaluate the effect of intraoperative perfusion assessment using IFA on operative decision-making and postoperative outcomes in patients with high-risk colorectal anastomoses.
Methods: A prospective cohort study was performed on patients undergoing intraoperative perfusion assessment using IFA during colorectal surgery at a single high-volume referral centre from 03/2018 to 08/2018. A high-risk anastomosis was defined as an extraperitoneal rectal anastomosis or emergency surgery. Use of IFA was at the surgeon’s discretion. Perfusion assessment involved a 3cc injection of reconstituted (25mg/10mL) ICG with subsequent IFA. Changes from planned transection lines were recorded. Secondary outcome was anastomotic leak rates within 30-days after surgery.
Results: 21 patients were included in this study (80% male, mean age 63 years (range 50-86), body mass index 27 kg/m2 (range 21-36). Most patients (90%; 19/21) underwent low anterior resection, including 43% transanal total mesorectal excisions. Another 2 patients underwent extended left hemicolectomy with a Deloyer’s procedure (right colon derotation and colorectal anastomosis). Changes in management based on ICG-IFA occurred in 29% (6/21) of patients. Four patients had revision of the proximal margin (range 2-10cm revision) and in 2 patients ICG-IFA allowed for an anastomosis to be performed in the context of middle colic artery division for a Deloyer’s prceodure. In the 6 patients where ICG-IFA altered management, only 1 patient experienced a complication (ileus). In the other 15 patients, only 1 patient experienced an anastomotic leak (7%).
Conclusion: In our early experience, selective use of ICG-IFA in patients with high-risk colorectal anastomoses results in changes in management in an important proportion of patients with good results. This technology may be of greatest value in selected high sk patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95549
Program Number: P359
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster