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Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials

  • Systematic Review and Meta-analysis
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Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Anastomotic leakage following gastrointestinal surgery remains a frequent and serious complication associated with a high morbidity and mortality. Indocyanine green fluorescence angiography (ICG-FA) is a newly developed technique to measure perfusion intraoperatively. The aim of this paper was to systematically review the literature concerning ICG-FA to assess perfusion during the construction of a primary gastrointestinal anastomosis in order to predict anastomotic leakage.

Methods

The following four databases PubMed, Scopus, Embase, and Cochrane were independently searched by two authors. Studies were included in the review if they assessed anastomotic perfusion intraoperatively with ICG-FA in order to predict anastomotic leakage in humans.

Results

Of 790 screened papers 14 studies were included in this review. Ten studies (n = 916) involved patients with colorectal anastomoses and four studies (n = 214) patients with esophageal anastomoses. All the included studies were cohort studies. Intraoperative ICG-FA assessment of colorectal anastomoses was associated with a reduced risk of anastomotic leakage (n = 23/693; 3.3 % (95 % CI 1.97–4.63 %) compared with no ICG-FA assessment (n = 19/223; 8.5 %; 95 % CI 4.8–12.2 %). The anastomotic leakage rate in patients with esophageal anastomoses and intraoperative ICG-FA assessment was 14 % (n = 30/214). None of the studies involving esophageal anastomoses had a control group without ICG-FA assessment.

Conclusion

No randomized controlled trials have been published. ICG-FA seems like a promising method to assess perfusion at the site intended for anastomosis. However, we do not have the sufficient evidence to determine that the method can reduce the leak rate.

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Authors and Affiliations

  1. Center for Surgical Science (CSS), Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark

    Thea Helene Degett, Helene Schou Andersen & Ismail Gögenur

Authors
  1. Thea Helene Degett
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  2. Helene Schou Andersen
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  3. Ismail Gögenur
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Correspondence to Thea Helene Degett.

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Conflict of interest

This study was done without external funding. Thea Helene Degett, Helene Schou Andersen and Ismail Gögenur all declare that they have no conflict of interest in this study. This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Thea Helene Degette and Helene Schou Andersen share first authorship. They have both contributed to the literature search, data retrieval, data analysis, and formation of the manuscript. Ismail Gögenur has contributed to the search strategy, selection of the included studies, data analysis, revision, and final approval of the manuscript.

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Degett, T.H., Andersen, H.S. & Gögenur, I. Indocyanine green fluorescence angiography for intraoperative assessment of gastrointestinal anastomotic perfusion: a systematic review of clinical trials. Langenbecks Arch Surg 401, 767–775 (2016). https://doi.org/10.1007/s00423-016-1400-9

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  • DOI: https://doi.org/10.1007/s00423-016-1400-9

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