Enhancing colorectal anastomotic safety with indocyanine green fluorescence angiography: An update.

Reducing anastomotic leak (AL) continues to be a main focus in colorectal research. Several new technologies have been developed with an aim to reduce this fluorescence angiography (FA) with indocyanine green (ICG) in colorectal surgery is now a well-established technique. By using FA we are able to have a visual representation of perfusion which aids intraoperative decision making. The main impact is change in the level of bowel transection at the proximal side of an anastomosis. Previous studies have shown that routine FA use is safe and reproducible. Recent results from randomized control trials and meta-analyses show that FA use reduces the rate of anastomotic leak. The main limitation of FA is its lack of ability to quantify perfusion. Novel technologies are being developed that will quantify tissue perfusion and oxygenation. Overall, FA is a safe technique and we would advocate its routine use.