Anastomotic leak and conduit necrosis are severe complications after esophagectomy. Fluorescent angiography with indocyanine green provides an opportunity to objectively evaluate conduit perfusion and, potentially, reduce the number of leaks.
Material and methods. We analyzed short-term outcomes of 26 esophagectomies performed with laser fluorescent evaluation of conduit perfusion. All patients had esophagogastic anastomosis, 14 in the neck, 12 in the pleural cavity. Conduit perfusion was assessed 30 sec after intravenous bolus injection of 6 mg of indocya-nine green with SPY2000 laser technology. The results were compared with short-term outcomes of 35 esophagectomies performed without fluorescent assessment of gastric tube perfusion.
Results. There were 6 leaks or conduit necrosis in control group while in the ICG group there were only 2 leaks on the neck: 1 in a patient with a massive intraoperative bleeding and shock, 1 in a patient with severely compromised blood supply of the gastric tube tip according to ICG imaging. No cases of conduit necrosis were found, which led to significantly lower number of severe (grade III-V Dindo-Clavien) complications, p=0,033. Conclusion Laser fluorescent angiography with indocyanine green is a useful tool which affords an objective evaluation of gastric tube perfusion and, potentially, reduces the number of severe postoperative complications after esophagectomy.
Laparoscopic diaphragmatic plication for diaphragmatic paralysis and eventration: An objective evaluation of short-term and midterm results
