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Outcomes using indocyanine green angiography with perforator-sparing component separation technique for abdominal wall reconstruction

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

Usage of intraoperative indocyanine green (ICG) to assess skin flaps prior to abdominal wall closure has been shown to decrease postoperative wound-related complications. Primary outcome assessed is the utility of ICG in intraoperative decision making. Secondary outcomes analyzed are the incidence of surgical site occurrence (SSO) and hernia recurrence rates.

Methods

A retrospective study using the MedStar Georgetown University Hospital database was conducted, incorporating all consecutive patients undergoing complex incisional hernia repair from 2008 to 2018. 146 patients underwent perforator-sparing component separation (PSCST), 88 underwent flap assessment using intraoperative ICG angiography; they were then analyzed based on patient comorbidities, Ventral Hernia Working Group grade, operative factors, and complications.

Results

A total of 146 patients were analyzed with no statistical difference in patient characteristics between the SPY and no SPY group except in BMI (30.2 vs. 33.2 kg/m2, p = 0.036). The no SPY group also had higher numbers of patients undergoing concurrent panniculectomy (12 vs. 1, p < 0.001), and extensive lysis of adhesions (30 vs. 31, p = 0.048). Of the 88 patients undergoing intraoperative SPY, 37 (42%) patients had a change of intraoperative management as defined by further subcutaneous skin flap debridement. Despite this change, there was no statistical difference in incidence of SSO between SPY and no SPY (24.3% vs. 11.8%, p = 0.12), and no difference in hernia recurrence rates 5.6% (n = 5) versus 13.7% (n = 8), p = 0.09.

Conclusion

Intraoperative ICG assessment of subcutaneous skin flaps with a perforator-sparing component separation does not result in a decrease in surgical site occurrences.

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Acknowledgements

Filiz Greenberg, BS, CPC, CPPM.

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Authors and Affiliations

  1. Department of Surgery, Medstar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, USA

    Jenny M. Shao, Yewande Alimi & Parag Bhanot

  2. Georgetown University School of Medicine, Washington, DC, USA

    Dylan Conroy

Authors
  1. Jenny M. Shao
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  2. Yewande Alimi
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  3. Dylan Conroy
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  4. Parag Bhanot
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Correspondence to Parag Bhanot.

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Disclosures

Dr. Parag Bhanot is a consultant to Allergan. Drs. Jenny Shao, Yewande Alimi, and Dylan Conroy have no conflicts of interest or financial ties to disclose.

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Shao, J.M., Alimi, Y., Conroy, D. et al. Outcomes using indocyanine green angiography with perforator-sparing component separation technique for abdominal wall reconstruction. Surg Endosc 34, 2227–2236 (2020). https://doi.org/10.1007/s00464-019-07012-5

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  • DOI: https://doi.org/10.1007/s00464-019-07012-5

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