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Indocyanine Green Fluorescence Imaging Helps In Visualization During Bowel Obstruction Surgery

According to a recent study, indocyanine green (ICG) fluorescence imaging can aid in the visualization of intestinal blood flow during laparoscopic surgery for strangulated colon blockage.

Indocyanine Green Fluorescence Imaging Helps In Visualization During Bowel Obstruction Surgery
Photo: Human Digestive System | InStyleHealth

The study included fourteen patients (median age 72.7 years, 64.3 percent men). After the reduction of an adhesion or hernia incarceration, small bowel color tone and peristalsis were examined under normal-light settings while under laparoscopic surgery. Then, using a near-infrared imaging instrument, 5 mg of ICG was injected into a peripheral vein and viewed.

The findings of both normal-light and near-infrared imaging were used to determine the final surgical plan (intestinal resection or preservation). The degree of intestinal necrosis was measured in the resection group, while postoperative problems were measured in the preservation group.

Four individuals qualified for resection after normal-light and near-infrared assessments, all of whom were determined to have necrosis. In all four patients, the intestinal wall was discolored black without perforation, and ICG fluorescence was barely discernible.

The ten patients who were advised for intestinal preservation, on the other hand, had a significant reduction in dark red coloration when the strangulation was removed, but their intestinal wall appearance was diverse. In these ten cases, ICG fluorescence was clearly apparent at a median time of 39.5 seconds. There were no problems such as delayed perforation or gastrointestinal stricture.

ICG fluorescence imaging may be a useful new source of evidence for improving intraoperative judgment in surgery for strangulated intestinal blockage. To clarify our findings, more evidence from trials with bigger patient groups is needed, according to the researchers.


Source: Asian J Surg 2021;doi:10.1016/j.asjsur.2021.08.020

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