Skip to main content

Indocyanine Green Fluorescent Angiography During Laparoscopic Sleeve Gastrectomy: Preliminary Results

Obesity Surgery volume 29, pages 3786–3790 (2019)Cite this article

Abstract

Introduction

Indocyanine green (ICG) fluorescent angiography has been routinely applied for various laparoscopic procedures to evaluate the tissue blood supply. A promising branch for this technology is represented by bariatric surgery, especially to estimate the risk of gastric leak after laparoscopic sleeve gastrectomy (LSG), which seems mainly related to ischemia of the stomach.

Materials and Methods

43 consecutive patients from January 2018 to March 2019 underwent in our institution LSG with intravenous injection of 5 ml ICG after the realization of gastric tube to evaluate the blood supply of the gastric tube.

Results

In all 43 cases, there have been no adverse events related to ICG. The vascular supply to stomach was estimated “satisfactory” along the stapled line in all cases. However, one patient showed signs and symptoms indicative of gastric leak in the fifth post-op day and diagnosis was confirmed by CT scan with Gastrografin.

Conclusions

From our preliminary data, the intraoperative view of the blood supply of the stomach does not seem to represent a prognostic factor for the risk of gastric leak, suggesting a complex multifactorial etiology (intragastric hypertension? Abnormal inflammatory response?) which needs further data to be established.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Ogden CL, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2011–2014: National Center for Health Statistics data brief; 2015. p. 29.

  2. Carubbi F, Ruscitti P, Pantano I, et al. Jejunoileal bypass as the main procedure in the onset of immune-related conditions: the model of BADAS. Expert Rev Clin Immunol. 2013;9(5):441–52.

    CAS  Article  Google Scholar 

  3. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017;25:1822–32.

    Article  Google Scholar 

  4. Galloro G, Ruggiero S, Russo T, et al. Staple-line leak after sleeve gastrectomy in obese patients: a hot topic in bariatric surgery. World J Gastrointest Endosc. 2015;7:843–6.

    Article  Google Scholar 

  5. Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20:13904–10.

    Article  Google Scholar 

  6. Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27:240–5.

    Article  Google Scholar 

  7. Marchese M, Romano L, Giuliani A, et al. Corrigendum to “A case of intrasplenic displacement of an endoscopic double-pigtail stent as a treatment for laparoscopic sleeve gastrectomy leak” [Int. J. Surg. Case Rep. 53 (2018) 367–369]. Int J Surg Case Rep. 2019;56:49. https://doi.org/10.1016/j.ijscr.2019.02.027.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Giuliani A, Romano L, Marchese M, et al. Gastric leak after laparoscopic sleeve gastrectomy: management with endoscopic double pigtail drainage. A systematic review. Surg Obes Relat Dis. 2019; pii: S1550-7289(19)30087-5. https://doi.org/10.1016/j.soard.2019.03.019. [Epub ahead of print]

    Article  Google Scholar 

  9. Perez M, Brunaud L, Kedaifa S, et al. Does anatomy explain the origin of a leak after sleeve gastrectomy? Obes Surg. 2014;24:1717–23.

    Article  Google Scholar 

  10. Giuliani A, Romano L, Papale E, et al. Complications post-laparoscopic sleeve gastric resection: review of surgical technique. Minerva Chir. 2019;74(3):213–7. https://doi.org/10.23736/S0026-4733.19.07883-0.

    Article  PubMed  Google Scholar 

  11. Degett TH, Andersen HS, Gögenur I. Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbeck's Arch Surg. 2016;401(6):767–75. https://doi.org/10.1007/s00423-016-1400-9.

    Article  Google Scholar 

  12. Boni L, Fingerhut A, Marzorati A, et al. Indocyanine green fluorescence angiography during laparoscopic low anterior resection: results of a case-matched study. Surg Endosc. 2017;31:1836–40.

    Article  Google Scholar 

  13. Jafari MD, Wexner SD, Martz JE, et al. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multiinstitutional study. J Am Coll Surg. 2015;220:82–92.

    Article  Google Scholar 

  14. Zehetner J, DeMeester SR, Alicuben ET, et al. Intraoperative assessment of perfusion of the gastric graft and correlation with anastomotic leaks after esophagectomy. Ann Surg. 2015;262:74–8.

    Article  Google Scholar 

  15. Deitel M, Gagner M, Erickson AL, et al. Third International Summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):749–59.

    Article  Google Scholar 

  16. Rosenthal RJ. International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of 412,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.

    Article  Google Scholar 

  17. Kim J, Azagury D, Eisenberg D, et al. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis. 2015;11(4):739–48. https://doi.org/10.1016/j.soard.2015.05.001.

    Article  PubMed  Google Scholar 

  18. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.

    Article  Google Scholar 

  19. Benedix F, Benedix DD, Knoll C, et al. Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity? Obes Surg. 2014;24(10):1610–6.

    Article  Google Scholar 

  20. Delle Monache S, Calgani A, Sanità P, et al. Adipose-derived stem cells sustain prolonged angiogenesis through leptin secretion. Growth Factors. 2016;34(3–4):87–96. https://doi.org/10.1080/08977194.2016.1191481.

    CAS  Article  PubMed  Google Scholar 

  21. Angrisani L, Cutolo PP, Buchwald JN, et al. Laparoscopic reinforced sleeve gastrectomy: early results and complications. Obes Surg. 2011;21(6):783–93.

    Article  Google Scholar 

  22. Chen B, Kiriakopoulos A, Tsakayannis D, et al. Reinforcement does not necessarily reduce the rate of staple line leaks after sleeve gastrectomy. A review of the literature and clinical experiences. Obes Surg. 2009;19(2):166–72.

    Article  Google Scholar 

  23. Dapri G, Cadière GB, Himpens J. Reinforcing the staple line during laparoscopic sleeve gastrectomy: prospective randomized clinical study comparing three different techniques. Obes Surg. 2010;20(4):462–7.

    Article  Google Scholar 

  24. Gentileschi P, Camperchioli I, D’Ugo S, et al. Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial. Surg Endosc. 2012;26(9):2623–9.

    Article  Google Scholar 

  25. Giannopoulos GA, Tzanakis NE, Rallis GE, et al. Staple line reinforcement in laparoscopic bariatric surgery: does it actually make a difference? A systematic review and metaanalysis. Surg Endosc. 2010;24(11):2782–8.

    Article  Google Scholar 

  26. Glaysher M, Khan OA, Mabvuure NT, et al. Staple line reinforcement during laparoscopic sleeve gastrectomy: does it affect clinical outcomes? Int J Surg Lond Engl. 2013;11(4):286–9.

    Article  Google Scholar 

  27. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and metaanalysis of 9991 cases. Ann Surg. 2013;257(2):231–7.

    Article  Google Scholar 

  28. Aggarwal S, Bhattacharjee H, Chander Misra M. Practice of routine intraoperative leak test during laparoscopic sleeve gastrectomy should not be discarded. Surg Obes Relat Dis. 2011;7(5):e24–5.

    Article  Google Scholar 

  29. Frattini F, Lavazza M, Mangano A, et al. Indocyanine green-enhanced fluorescence in laparoscopic sleeve gastrectomy. Obes Surg. 2015;25(5):949–50. https://doi.org/10.1007/s11695-015-1640-8.

    Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of General Surgery, Hospital San Salvatore L’Aquila, University of L’Aquila, L’Aquila, Italy

    Marino Di Furia, Lucia Romano, Andrea Salvatorelli, Denise Brandolin, Giovanni Cianca, Mario Schietroma, Francesco Carlei & Antonio Giuliani

  2. Department of Surgery, Division of Upper Gastrointestinal Surgery, National University Hospital, Singapore, Singapore

    Davide Lomanto

Authors
  1. Marino Di Furia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucia Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Salvatorelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Denise Brandolin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Davide Lomanto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giovanni Cianca
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mario Schietroma
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francesco Carlei
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Giuliani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marino Di Furia.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Di Furia, M., Romano, L., Salvatorelli, A. et al. Indocyanine Green Fluorescent Angiography During Laparoscopic Sleeve Gastrectomy: Preliminary Results. OBES SURG 29, 3786–3790 (2019). https://doi.org/10.1007/s11695-019-04085-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-019-04085-y

Keywords

  • Sleeve Gastrectomy
  • Indocyanine green fluorescent angiography
  • Obesity
  • Gastric leakage