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Fluorescence angiography vs. direct palpation for bowel viability evaluation with strangulated bowel obstruction

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Abstract

Purpose

In surgery for strangulated bowel obstruction, intestinal blood flow (IBF) is usually evaluated by observing bowel colour, peristalsis, intestinal temperature and arterial pulsations in the mesentery. We investigated whether indocyanine green (ICG) fluorescence angiography (ICG-FA) is an effective alternative to palpation.

Methods

Thirty-eight patients who underwent emergency surgery for strangulated bowel obstruction from January 2017 to April 2021 were divided into two groups: (i) the ICG + group, in which ICG was used during laparoscopic surgery (n = 16), and (ii) the ICG − group, in which palpation without ICG was used during open surgery (n = 22). Starting in July 2019, ICG and laparoscopic surgery were applied in all cases except emergency cases when the fluorescence laparoscope was not ready. Surgical outcomes and patient characteristics were compared.

Results

Patient characteristics, the operative duration and postoperative hospitalization duration did not significantly differ between the groups. Bowel resection was performed in 4 cases (25%) among ICG + patients and 11 cases (50%) among ICG − patients. The ratios of pathological findings (ischaemia:mucosal necrosis:transmural necrosis) were 0:2:2 and 1:6:4 in the two groups, respectively. Blood loss was measured with gauze and suction tubes and was 1 (0–5) mL in the ICG + group and 12.5 (0–73) mL in the ICG − group (p = 0.002). Postoperative complications occurred in 1 case (6.3%) in the ICG + group and 9 cases (40.9%) in the ICG − group (p = 0.025).

Conclusion

Although there were few intestinal resections in the ICG + group, the rate of pathological necrosis tended to be high, and no complications due to ineligibility were noted in the intestinal preservation group. During laparoscopic surgery, ICG-FA is useful as a substitute for palpation and has the potential to improve surgical outcomes.

Clinical trial registration

Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2019–40

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Data availability

The data and material that support the findings of this study are available from the corresponding author upon request.

Code availability

None.

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Acknowledgements

The authors would like to thank Professor Masashi Yoshida (Department of Surgery, International University of Health and Welfare Hospital) for his invaluable advice regarding fluorescence navigation surgery.

The authors would like to thank the medical staff of the Kawaguchi Municipal Medical Center.

Funding

This work was supported by the 35th Saitama Surgeons Association Research Grant.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City , Saitama, 333-0833, Japan

    Shunjin Ryu, Keigo Hara, Keisuke Goto, Atsuko Okamoto, Takahiro Kitagawa, Rui Marukuchi, Ryusuke Ito & Yukio Nakabayashi

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  1. Shunjin Ryu
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  2. Keigo Hara
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  3. Keisuke Goto
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Contributions

SR: data curation, formal analysis, project administration, writing—original draft, writing—review and editing, conceptualization, methodology and visualization. KH: investigation. KG: investigation. AO: investigation. TK: investigation. RM: investigation. RI: investigation. YN: supervision.

Corresponding author

Correspondence to Shunjin Ryu.

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Ethics approval

This study was carried out with the approval of the Kawaguchi Municipal Medical Center Ethics Committee (approval number: 2019–40).

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The authors declare no competing interests.

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Ryu, S., Hara, K., Goto, K. et al. Fluorescence angiography vs. direct palpation for bowel viability evaluation with strangulated bowel obstruction. Langenbecks Arch Surg 407, 797–803 (2022). https://doi.org/10.1007/s00423-021-02358-8

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  • DOI: https://doi.org/10.1007/s00423-021-02358-8

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