Does near-infrared (NIR) fluorescence angiography modify operative strategy during emergency procedures?

Abstract

IntroductionBowel viability can be difficult to evaluate during emergency surgery. Near-infrared (NIR) fluorescence angiography allows an intraoperative assessment of organ perfusion during elective surgery and might help to evaluate intestinal perfusion during emergency procedures. The aim of this study was to assess if NIR modified operative strategy during emergency surgery.Materials and methodsFrom July 2014 to December 2015, we prospectively evaluated all consecutive patients, who had NIR assessment during emergency surgery. Primary endpoint was the modification of operative strategy after the assessment with NIR. Secondary endpoints were general post-operative outcomes, including reoperation rate.ResultsFifty-six patients were included in the study. Mean age was 64 ± 17 years. An exploratory laparoscopy was performed in 39% (n = 22) and an open surgery in 61% of cases (n = 34). Conversion rate to open surgery was 41% (n = 9). 32 patients had a bowel resection. In 32% of the cases (n = 18), the result of the NIR test led to a modification of the operative strategy. Among them, 33% (n = 6) had a larger resection or a resection, which was initially not planned. The other 12 patients (67%) had finally no resection, which was initially thought to be performed. Importantly, none of those patients needed a reoperation for ischemia. Mean time for performing NIR test was 167 s (± 121). Overall reoperation rate was 16.1% (n = 9). Two patients had an anastomotic leak. Eight patients (14.3%) died within the first 30 post-operative days; however, none of them presented a bowel ischemia or an anastomotic leak.ConclusionNIR is an easy and short procedure, which can be performed during emergency surgery to assess bowel perfusion. It may help the surgeon to preserve intestinal length or to define the exact limits of resection. Overall, we report a modification of operative strategy in up to one-third of evaluated patients.Electronic supplementary materialThe online version of this article (10.1007/s00464-018-6226-9) contains supplementary material, which is available to authorized users.

Clinical features of patients with hepatic portal venous gas

“…In particular, three out of four patients who underwent bowel resection and primary anastomosis suffered from anastomotic leak, which directly lead to mortality, suggesting that the use of an earlier second-look laparotomy and/or a prophylactic stoma should be considered in such patients. Modern surgical techniques, such as fluorescent angiography for the verification of intraoperative vascular perfusion, might have a positive effect on the prognosis of those who are predisposed to postoperative anastomotic leak [24]. We also found that the peritoneal irritation sign, several laboratory findings on admission (BE, lactate, NLR, and CRP), and IP on CT represented potential prognostic factors for bowel ischemia in the full cohort with HPVG, although this finding was based on univariable analyses, because of the relatively small sample size.…”

“…In particular, three out of four patients who underwent bowel resection and primary anastomosis suffered from anastomotic leak, which directly lead to mortality, suggesting that the use of an earlier second-look laparotomy and/or a prophylactic stoma should be considered in such patients. Modern surgical techniques, such as fluorescent angiography for the verification of intraoperative vascular perfusion, might have a positive effect on the prognosis of those who are predisposed to postoperative anastomotic leak [ 24 ].…”

Clinical features of patients with hepatic portal venous gas

“…Modern surgical techniques, such as uorescent angiography for the veri cation of intraoperative vascular perfusion, might have a positive effect on the prognosis of those who are predisposed to postoperative anastomotic leak [21].…”

Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia

“…These tools include Laser Doppler Flowmetry (LDF) and fluorescence imaging (FI). The former method is one of the pioneers in gut perfusion assessment [ 13 , 14 , 15 , 16 , 17 ], whereas the latter is widely used in contemporary clinical practice [ 18 , 19 , 20 , 21 ]. Note that the use of LDF has not become widespread in AMI affected patients, even though the method continues to be of interest in experimental studies of intestinal tissue damage following ischemia/reperfusion injury [ 22 , 23 ].…”