To evaluate feasibility of near-infrared indocyanine green (NIR-ICG) imaging for bowel vascularization assessment after full thickness bowel resection for recto-sigmoid endometriosis (RSE).
This is a prospective, single-center, preliminary study on consecutive symptomatic patients submitted to discoid or segmental resection for RSE and NIR-ICG evaluation for vascular assessment of anastomotic line, from May 2018 to January 2020.
Tertiary university hospital.
Thirty-two women with RSE meeting eligibility criteria were included for study analysis.
NIR-ICG evaluation of anastomotic line vascularization after RSE removal.
Fluorescence degree of anastomotic line was assessed with a 0-2 Likert scale, as follow: 0 or “absent” (no fluorescence observed), 1 or “irregular” (not uniform distribution or weak fluorescence), and 2 or “regular” (uniform distribution of fluorescence and similar to proximal colon).
In all the patients included in the study (100%) NIR-ICG allowed the evaluation of fluorescence degree of the anastomotic line. No adverse reaction related to ICG use was recorded. The protocol did not greatly lengthen operating time [median, 4 (range, 3-5) minutes]. Excellent inter-operator agreement was observed. Most of the patients (31/32, 96.9%) showed regular fluorescence on anastomotic line; in one patient with irregular fluorescence at NIR-ICG after discoid excision, anastomotic suture was reinforced through interrupted stitches. Notably, we had one case of anastomotic leakage after segmental resection with intraoperative good fluorescence at NIR-ICG evaluation.
NIR-ICG imaging for anastomotic perfusion assessment after discoid or segmental resection for RSE seems to be a feasible, safe and reproducible method.
Copyright © 2020. Published by Elsevier Inc.