Optimizing omentoplasty for management of chronic pelvic sepsis by intra‐operative fluorescence angiography: a comparative cohort study

Abstract

Aim Pelviperineal wound complications frequently occur after salvage surgery for chronic pelvic sepsis despite using an omentoplasty. Sufficient perfusion of the omentoplasty following mobilization is essential for proper healing. This study investigated the impact on short-term clinical outcomes of fluorescence angiography (FA) using indocyanine green for assessment of omental perfusion in patients undergoing salvage surgery. Method This was a comparative cohort study including consecutive patients who underwent combined abdominal and transanal minimally invasive salvage surgery with omentoplasty at a national referral centre for chronic pelvic sepsis between December 2014 and August 2019. The historical and interventional cohorts were defined based on the date of introduction of FA in April 2018. The primary outcome was pelviperineal non-healing, defined by the presence of any degree of pelviperineal infection at the final postoperative evaluation. Results Eighty-eight patients underwent salvage surgery with omentoplasty for chronic pelvic sepsis, of whom 52 did not have FA and 36 did have FA. The underlying primary disease was Crohn's disease (n = 50) or rec-tal cancer (n = 38), with even distribution among the cohorts (P = 0.811). FA led to a change in management in 28/36 (78%) patients. After a median of 89 days, pelviperineal non-healing was observed in 22/ 52 (42%) patients in the cohort without FA and in 8/ 36 (22%) patients in the cohort with FA (P = 0.051). Omental necrosis was found during reoperation in 3/ 52 and 0/36 patients, respectively (P = 0.266). Conclusion After introduction of FA to assess perfusion of the omentoplasty, halving of the pelviperineal nonhealing rate was observed in patients undergoing salvage surgery for chronic pelvic sepsis.

Fluorescence-guided surgery in colorectal cancer; A review on clinical results and future perspectives

“…Remarkably, ICG fluorescence angiography led to a change in surgical management in 80% of the patients. A follow up study by the same group showed a decrease in pelviperineal non-healing in the ICG group compared to the control group (22% vs 42%; p ¼ 0.051) [95]. However non-significant, this study showed a trend towards improved outcomes after ICG fluorescence angiography guided omentoplasty.…”

Omentoplasty in Patients Undergoing Abdominoperineal Resection After Long-Course Chemoradiation for Locally Advanced and Locally Recurrent Rectal Cancer: A Comparative Single-Institution Cohort Study

“…First, the mobilization of the greater omentum might jeopardize its vascularization, leaving a (partially) devascularized omentum in the neo-pelvis. 19,20 A partially devascularized, necrotic omentum could be a source of infection, balancing out the potential benefit of an omentoplasty. Finally, an imbalance regarding the extent of APR might have contributed to the higher pelviperineal complication rate after omentoplasty.…”

Indocyanine Green Fluorescence Guided Surgery in Colorectal Surgery

“…In 2019, Slooter et al reported a pilot study for assessing omental perfusion during omentoplasty in salvage surgery for pelvic sepsis [ 21 ]. After establishing the feasibility of this technique, the same group went on to demonstrate the possible beneficial role in a subsequent cohort study [ 22 ]. They reported a much lower perineal non-healing rate in the group where ICG was utilized (22%) versus the controls (42%).…”