Jun Higashijima, PhD, Mitsuo Shimada, Professor, Kozo Yoshikawa, PhD, Takuya Tokunaga, PhD, Masaaki Nishi, PhD, Hideya Kashihara, PhD, Chie Takasu, PhD, Daichi Ishikawa, PhD. Department of Surgery, The University of Tokushima
Background: One of the important causes for anastomotic leakage (AL) in anterior resection is an insufficient blood flow of the stump. The HEMS (Hyper eye medical system) and SPIES (laparoscopic ICG system) can detect the blood flow of fresh organ intraoperatively by injection of indocyanine green (ICG). And thermography also can evaluate the bloodflow less invasively. The aim of this study is to evaluate the usefulness of ICG system and thermography in laparoscopic anterior resection.
Patients and Methods: This study retrospectively included 86 patients who underwent laparoscopic anterior resection for colon cancer with double stapling anastomosis procedure. Blood flow evaluation of oral stumps was performed with measurement of fluorescence time (FT) using HEMS and SPIES. And bloodflow was also evaluated by thermography.
Result: Evaluation by ICG system : In all cases, the AL rate was 8.1% (7/86 cases). Over 60 FT cases, the AL rate was 60%, higher than that of under 60 sec cases and these patinets need additional management , covering stoma or additional resection. And in border cases, FT 50~60sec, AL rate is 10.0%, higher than under 50 sec cases. In these borderline cases, if covering stoma was performed in patinets with more than three well known risk factors, the AL rate reduced to 2.6% and false positive was 6.9%. And under 50 seconds cases , they need no additional management.
Evaluation by thermography : In residual intestine, the temperature was siginificantly higher than resected intestine (31.5 vs 29.0?, p<0.01). And the temperature in FT under 50 seconds cases was significantly higher than over FT over 50seconds cases(26.3 vs 30.8?). The temperatue and FT was tended to be oppositely correlated (R2=0.36).
Conclusion: Both ICG system and thermography may be useful to avoid anastomotic leakage.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87170
Program Number: P285
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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