Peristeri Dimitra V, Singh Rowdhwal Sai Sandeep
Department of Upper GI Surgery, Frimley Park Hospital, Frimley NHS Foundation Trust, UK.
Department of General Surgery and Liver Transplant Surgery, Manipal Hospitals Vijayawada, Tadepalle, India.
Surg Innov. 2025 Aug;32(4):392-403. doi: 10.1177/15533506251339931. Epub 2025 May 1.
BackgroundPost-operative anastomotic leaks (AL) are one of the most challenging complications of bariatric surgery and can be detrimental. Indocyanine green (ICG) is a fluorescence dye that can provide a real-time intraoperative assessment of organ tissue perfusion. Its use in bariatric operations is still being debated. The present review aims to evaluate the intraoperative utility of ICG during bariatric surgery to focus future research on a reliable tool to reduce the incidence of postoperative leaks.MethodsA systematic search of PubMed, EMBASE, MEDLINE, Scopus, and the Cochrane Library for published studies took place until December 2024, evaluating the use of ICG during bariatric surgical procedures. Studies were included if they assessed the ICG application in various bariatric operations to prevent and reduce AL rates.ResultsEleven studies were included, which involved a total of 887 patients. 643 patients underwent ICG-based intraoperative assessments, while 244 were in the control group. The mean age of participants was 43.8 years, and the mean BMI was 43.3 kg/m. All included patients underwent various bariatric procedures. ICG was used alone in most studies, although it was mixed with methylene blue in one study. ICG administration protocols varied significantly. There were no reported complications from ICG administration. The utility of ICG has changed the intraoperative surgical decision-making of 4.2% of patients.ConclusionsICG is a promising technique for successfully preventing or timely managing AL in bariatric surgery. Large, randomised controlled studies are needed to confirm its utility for routine use in primary and revisional bariatric cases.
背景
术后吻合口漏（AL）是减肥手术中最具挑战性的并发症之一，可能会产生不利影响。吲哚菁绿（ICG）是一种荧光染料，可在术中实时评估器官组织灌注情况。其在减肥手术中的应用仍存在争议。本综述旨在评估ICG在减肥手术中的术中效用，以便将未来的研究重点放在一种可靠的工具上，以降低术后漏的发生率。
方法
对PubMed、EMBASE、MEDLINE、Scopus和Cochrane图书馆进行系统检索，以查找截至2024年12月发表的研究，评估ICG在减肥手术过程中的应用。如果研究评估了ICG在各种减肥手术中的应用以预防和降低AL发生率，则纳入该研究。
结果
纳入了11项研究，共涉及887例患者。643例患者接受了基于ICG的术中评估，而244例在对照组。参与者的平均年龄为43.8岁，平均BMI为43.3kg/m²。所有纳入患者均接受了各种减肥手术。在大多数研究中，ICG单独使用，尽管在一项研究中它与亚甲蓝混合使用。ICG给药方案差异很大。未报告ICG给药引起的并发症。ICG的效用改变了4.2%患者的术中手术决策。
结论
ICG是一种有前景的技术，可成功预防或及时处理减肥手术中的AL。需要进行大型随机对照研究，以确认其在原发性和修订性减肥病例中常规使用的效用。
