Department of General Surgery, Hospital San Salvatore L'Aquila, University of L'Aquila, L'Aquila, Italy.
Department of Surgery, Division of Upper Gastrointestinal Surgery, National University Hospital, Singapore, Singapore.
Obes Surg. 2019 Dec;29(12):3786-3790. doi: 10.1007/s11695-019-04085-y.
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.
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.
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.
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.
吲哚菁绿（ICG）荧光血管造影术已常规应用于各种腹腔镜手术，以评估组织血液供应。这项技术的一个很有前途的分支是用于减重手术，特别是评估腹腔镜袖状胃切除术（LSG）后胃漏的风险，这似乎主要与胃缺血有关。
2018 年 1 月至 2019 年 3 月，我院对 43 例连续患者行 LSG，在完成胃管后，静脉注射 5mlICG 以评估胃管的血液供应。
在所有 43 例患者中，均未发生与 ICG 相关的不良事件。在所有病例中，吻合线处的胃血管供应均被评估为“满意”。然而，有 1 例患者在术后第 5 天出现胃漏的症状和体征，并通过 CT 扫描加泛影葡胺证实诊断。
根据我们的初步数据，胃血供的术中观察似乎不能作为胃漏风险的预后因素，提示存在复杂的多因素病因（胃内高压？异常炎症反应？），需要进一步的数据来证实。
