The impact of indocyanine green fluorescence angiography in changing the planned surgical site resection on the rates of colorectal anastomotic leak: our early experience

Background Anastomotic leak (AL) is one of the most serious complications of colonic resection with a mortality rate of similar to 12-21%. Despite the advances in laparoscopic systems and anastomotic techniques, the AL rate is still high (6-15%). Poor perfusion at the anastomotic site is a major cause of AL. Indocyanine green fluorescence angiography (ICG-FA) can be used to ensure good perfusion at the resection site to construct secure anastomosis. Aim To evaluate the impact of ICG-FA on changing the surgical site resection and its impact on colorectal AL rate compared with traditional white light assessment of the resection site. Patients and methods This is a prospective interventional comparative study that included patients who underwent successful laparoscopic colectomy during the period between August 2020 and February 2022. In all, 39 patients were included in the study and were divided into two groups: The ICG-FA group included 16 patients in which we used ICG-FA to assess the perfusion at the resection site before performing anastomosis. The control group included 23 patients in which the perfusion of the anastomotic site was assessed under white light. Results The assessment of the perfusion using ICG-FA led to a change in the surgical plan in two (12.5%) patients. The leak rate was 6.3% (one patient) in the ICG-FA group compared with 8.7% (two patients) in the control group. The decrease in AL was not statistically significant and we cannot prove that changing the surgical plan using ICG-FA reduced the leakage rate because of the small sample size. So, larger prospective, randomized controlled trials are recommended to prove its efficacy.