ICG fluorescence imaging improves intraoperative judgement during bowel obstruction surgery

Indocyanine green (ICG) fluorescence imaging can help visualize intestinal blood flow better during laparoscopic surgery for strangulated bowel obstruction, a recent study has found.

Fourteen patients (median age 72.7 years, 64.3 percent men) participated in the study. While under laparoscopic surgery, small bowel colour tone and peristalsis were viewed under normal-light conditions after the reduction of an adhesion or hernia incarceration. Subsequently, 5 mg of ICG was injected via the peripheral vein and visualized using a near-infrared imaging device.

The final surgical plan (intestinal resection or preservation) was based on the findings of both normal-light and near-infrared imaging. In the case of resection, the degree of intestinal necrosis was assessed, while postoperative complications were evaluated in the preservation group.

After both normal-light and near-infrared observations, four patients qualified for resection, all of whom were found to have necrosis. Similarly, all four patients had black discolouration of the intestinal wall without perforation, and ICG fluorescence was hardly visible.

In contrast, the 10 patients who were recommended for intestinal preservation showed marked reduction in dark red colouration after the strangulation was removed, but otherwise had variable intestinal wall appearance. ICG fluorescence was clearly visible in these 10 cases, manifesting after a median time of 39.5 seconds. No complications such as delayed perforation and gastrointestinal stricture were observed.

“In surgery for strangulated bowel obstruction, ICG fluorescence imaging may be a useful novel source of evidence for improving intraoperative judgment. Further evidence from studies with larger patient populations are necessary to clarify our findings,” the researchers said.