A. Dinallo1, W. Boyan1, B. Protyniak1, A. James1, R. Dressner1, M. Arvanitis1 1Monmouth Medical Center,Surgery,Long Branch, NEW JERSEY, USA
Introduction: Major factors to prevent anastomotic leaks include adequate perfusion, tension free and minimal spillage. Conventional techniques to assess viability of bowel perfusion such as palpating pulses and evaluating color and bleeding of cut edges are all critical techniques during colorectal surgery; however they are subjective. Like all medical practice, concrete objective data would be ideal while performing an anastomosis during colorectal surgery. The use of Indocyanine Green Fluorescence Angiography seeks to provide objective data when assessing tissue perfusion.
Methods: Between June 2013 and November 2015, 176 colorectal resections were retrospectively reviewed. The perfusion to the colon and ileum was clinically assessed, and then measured using SPY Elite Imaging System. The absolute value provided an objective number on a 0-256 gray scale, which represents differences between ICG fluorescence intensity and therefore perfusion. The lowest absolute value was used in data analysis as it represented the least perfused anastomotic portion.
Results: There were 93 resections done for malignant disease and 83 resections performed for benign disease. There were a total of eleven operations that required additional proximal resections due to low ICG readings. Complications included two anastomotic leaks (1.1%) and three stenoses (1.7%). One anastomotic leak resulted in a mortality from sepsis. The mean ICG absolute values for all of the colon resections was greater than 51.
Conclusion: This study represents a 29-month experience at a single institution using the SPY technology in colorectal surgery. To date this the largest collection of data using SPY to objectively assess bowel perfusion in creating an anastomosis. The statistical significance of these values in relation to perfusion and anastomotic leaks has yet to be established in the literature. To determine these values randomized control trials are required.