B.T. Hickner1,2, A.F. Espinoza1,2, T.C. Lee1,2, E.A. Onwuka1,2, S.A. Vasudevan1,2, L. Cheng3, K.L. Rialon1,2 1Texas Children’s Hospital, Houston, TX, USA 2Baylor College Of Medicine, Division Of Pediatric Surgery, Department Of Surgery, Houston, TX, USA 3University of Virginia, Division Of Pediatric Surgery, Department Of Surgery, Charlottesville, VA, USA
Introduction: Ensuring adequate intestinal perfusion during posterior sagittal anorectoplasty (PSARP), cloacal reconstruction, and pull-through for Hirschsprung disease is crucial to prevent complications in pediatric colorectal surgery. Indocyanine green (ICG) fluorescence angiography has previously been shown to correctly identify insufficient perfusion during these procedures. We aimed to study the short-term outcomes and intraoperative complications associated with utilization of ICG fluorescence angiography.
Methods: A retrospective chart review was performed of 175 patients that underwent PSARP, cloacal reconstruction, and pull-through for Hirschsprung disease at a single institution from August 2016 to June 2024. Primary outcomes included anastomotic leak, dehiscence, and reoperation. Length of hospital stay was assessed as a secondary outcome. Chi square and Student’s t-test (two-tailed) were utilized for statistical analysis.
Results: We identified 26 patients that received ICG intraoperatively and 149 that did not. The dose of ICG received mg/kg varied between 0.06 and 0.36 mg/kg (median 0.17, IQR 0.13 – 0.23). A higher proportion of patients in the ICG group underwent cloacal reconstruction and re-do procedures (Table 1). In the non-ICG group, 18 patients (12.1%) experienced anastomotic leak or dehiscence compared to 3 patients in the ICG cohort (11.5%, p=0.94). In the ICG cohort, five patients (19.2%) had an unplanned return to the operating room compared to 39 patients in the non-ICG group (26.2%, p=0.45). The median estimated blood loss (milliliters) documented in the surgical record of the non-ICG group was five (IQR 3-10) versus 10 (IQR 5-20) for the ICG (p=0.03). The median length of hospital stay for the non-ICG group was six days (IQR 3-10.5) versus seven days (IQR 5-11) for the ICG group (p=0.28). The median time of surgery (minutes) for the non-ICG group was 196 (IQR 150-262) versus the ICG group was 496 (IQR 394 – 607, p < 0.001).
Conclusion: The dose of ICG varied widely across our cohort. The use of ICG was associated with longer operative times and increased procedure complexity. However, patients in the ICG group had similar complications and length of stay. Difference in blood loss was statistically, but not clinically, significant. Further investigation into the role of ICG in preventing complications, particularly for cases of increased complexity, is warranted.