Elmajdub Ahmed, Brebesh Nahed, Maatough Annis, Willeke Frank, Weiss Christel, Darwich Ibrahim
Marien-Krankenhaus Siegen: Marien Kliniken Siegen, Siegen, Germany.
Department of Surgery, Tripoli University, Tripoli, Libya.
Updates Surg. 2025 Jan;77(1):83-95. doi: 10.1007/s13304-024-02036-6. Epub 2024 Dec 2.
Anastomotic leaks are a significant complication in colorectal surgery. Indocyanine green fluorescence angiography (ICG-FA) has been suggested as a method to reduce the risk. This meta-analysis aims to evaluate the effect of ICG-FA on reducing anastomotic leaks in colorectal surgery. This study follows PRISMA guidelines and is registered on PROSPERO (CRD42022370748). We conducted a comprehensive search of multiple databases and registers for randomized controlled trials (RCTs) comparing ICG-FA with standard methods in colorectal surgery. Data extraction and quality assessment were performed by two independent reviewers, with a third resolving disputes. Odds ratios (OR) and mean differences (MD) were calculated using comprehensive meta-analysis software, version 3. Heterogeneity and publication bias were assessed, and a sensitivity analysis was performed. The analysis included five RCTs with a total of 1369 patients from four countries. The ICG-FA was associated with a 45% reduction in the risk of overall anastomotic leaks (OR: 0.550, p = 0.012). Subgroup analysis showed a 47% reduction in leaks for low anastomoses (OR: 0.53, p = 0.143) and a 69% reduction in grade A leaks (OR: 0.31, p = 0.008). No significant effects were observed for grade B and C leaks, blood loss, surgery duration, hospital stay, mortality, postoperative ileus, reoperation, or surgical site infections. ICG-FA significantly reduces the overall risk of anastomotic leaks, especially grade A leaks, and shows a trend towards fewer leaks in low anastomosis. No significant impact was found on secondary outcomes. Further RCTs are needed to confirm these findings.
吻合口漏是结直肠手术中的一种严重并发症。吲哚菁绿荧光血管造影术（ICG-FA）已被提议作为一种降低风险的方法。本荟萃分析旨在评估ICG-FA在降低结直肠手术吻合口漏方面的效果。本研究遵循PRISMA指南，并在PROSPERO（CRD42022370748）上注册。我们对多个数据库和登记处进行了全面检索，以查找比较ICG-FA与结直肠手术标准方法的随机对照试验（RCT）。由两名独立的评审员进行数据提取和质量评估，如有争议则由第三名评审员解决。使用综合荟萃分析软件3.0计算比值比（OR）和平均差（MD）。评估了异质性和发表偏倚，并进行了敏感性分析。该分析纳入了5项RCT，共1369例来自4个国家的患者。ICG-FA与总体吻合口漏风险降低45%相关（OR：0.550，p = 0.012）。亚组分析显示低位吻合口漏减少47%（OR：0.53，p = 0.143），A级漏减少69%（OR：0.31，p = 0.008）。对于B级和C级漏、失血量、手术时间、住院时间、死亡率、术后肠梗阻、再次手术或手术部位感染，未观察到显著影响。ICG-FA显著降低了吻合口漏的总体风险，尤其是A级漏，并且在低位吻合中显示出漏出减少的趋势。对次要结局未发现显著影响。需要进一步的RCT来证实这些发现。
