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Indocyanine green fluorescent imaging on anastomotic leakage in colectomies: a network meta-analysis and systematic review

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Abstract

Purpose

The usage of indocyanine green (ICG) dye is commonly associated with decreased anastomotic leakage rates in colectomies. This study aims to perform a network meta-analysis to assess the usage of ICG fluorescence imaging in right-sided colectomies.

Methods

Medline, Embase, Cochrane Trials, CNKI, and WanFang electronic databases were reviewed, and meta-analysis of proportions, comparative meta-analysis, and network meta-analysis were conducted in this review. Studies comparing ICG usage with conventional approaches of anastomosis were selected, with postoperative anastomotic leak rate being the primary outcome.

Results

Ten articles were included, with a total of 675 patients involved, of which 515 patients underwent colorectal surgery with ICG. Anastomotic leak rates with ICG were estimated to be 1% (CI 0.00–0.04) and 3% (CI 0.01–0.06) for right and left procedures, respectively. No significant difference was observed in left-sided colectomies (OR 0.587; 95% CI 0.218–1.582; p = 0.292). There were nearly half the odds of anastomotic leakage when ICG was used in right-sided colectomies (OR 0.524; 95% CI 0.128–2.137).

Conclusion

With the ability to potentially avert postoperative anastomotic leakage, coupled with its minimal costs and side effects, administration of ICG in colectomies in centers where equipment is available should be encouraged.

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Acknowledgments

We would like to thank Ms Annelisa for her guidance in formatting the search strategy and for searching the Chinese databases CNKI and WanFang.

Availability of data and material

All data are available upon request.

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Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore

    Hao Ting Mok, Zhi Hao Ong, Clyve Yu Leon Yaow & Cheng Han Ng

  2. Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Bryan Jun Liang Buan & Choon Seng Chong

  3. Department of General Surgery, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Neng Wei Wong

Authors
  1. Hao Ting Mok
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  2. Zhi Hao Ong
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  7. Choon Seng Chong
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hao Ting Mok, Zhi Hao Ong, Clyve Yu Leon Yaow, and Cheng Han Ng. The first draft of the manuscript was written by all authors, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Choon Seng Chong.

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Mok, H.T., Ong, Z.H., Yaow, C.Y.L. et al. Indocyanine green fluorescent imaging on anastomotic leakage in colectomies: a network meta-analysis and systematic review. Int J Colorectal Dis 35, 2365–2369 (2020). https://doi.org/10.1007/s00384-020-03723-7

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  • DOI: https://doi.org/10.1007/s00384-020-03723-7

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