Abstract
The two most essential technical aspects of any gastrointestinal anastomosis are adequate perfusion and sufficient reach. For ileal pouch-anal anastomosis (IPAA), a trade-off exists between these two factors, as lengthening manoeuvers to avoid tension may require vascular ligation. In this technical note, we describe two cases in which we used indocyanine green (ICG) fluorescence angiography (FA) to assess perfusion of the pouch after vascular ligation to acquire sufficient reach. In both cases, FA allowed us to distinguish better between an arterial inflow problem and venous congestion than white light assessment. Both pouches remained viable and no anastomotic leakage occurred. Our results indicate that ICG FA is of great value after vascular ligation to obtain reach during IPAA.
Highlights
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice in patients with familial adenomatous polyposis (FAP), ulcerative colitis (UC) and well-selected patients with Crohn’s colitis [1]
Spinelli et al [8] have shown that the postoperative anastomotic leakage rate after IPAA in their fluorescence angiography (FA) group was similar to that in a non-FA group, even though ligation of the ileocolic artery was performed more often within the FA group than non-FA group (47% versus 16%)
We demonstrate the potential value of FA in decision making after ligation of vessels to obtain adequate length for a tension-free anastomosis in two cases
Summary
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice in patients with familial adenomatous polyposis (FAP), ulcerative colitis (UC) and well-selected patients with Crohn’s colitis [1]. Keywords Fluorescence angiography (FA) · Indocyanine green (ICG) · Ileal pouch-anal anastomosis (IPAA) · Vascular ligation · Anastomotic leakage To acquire length in IPAA, routine lengthening measures are taken that include mobilization of the mesenteric root up to the duodenum and bilateral transverse peritoneal incisions approximately every 3 cm. In case adequate length cannot be obtained by these routine manoeuvers, tailored lengthening measures, involving
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