Intraluminal administration of indocyanine green as a method of intraoperative diagnostic of staple line leak during sleeve gastrectomy in an experiment.

Abstract

Background: Bariatric surgery is an actively developing branch of surgery. At the same time, thanks to the use of modern hardware methods for disconnecting and stitching tissue, the number of postoperative complications have significantly decreased. However, staple line failure is still quiet high and the cause of severe postoperative complications. Traditional methods for intraoperative diagnosis of leakage are provocative tests: tests with methylene blue and air. One of the promising methods of intraoperative control in surgery is the use of indocyanine green (ICG) test . Aims: The purpose of the study is to assess the diagnostic value of intraoperative using fluorescent imaging with indocyanine green (ICG) in case of staple line leak during sleeve gastrectomy (SG) by modeling in pig models various causes of staple line failure using morphological studies. Methods: The study was carried out on 20 pigs, each of which underwent SG. The animals were divided into few groups: a control group standard SG (n=4), a group of SG with mechanical failure of staple line(n=12), and a group of SG with local ischemia of staple line (n=4). To assess a staple line leak methylene blue and indocynin green was injected into the stomach. The appearance of the methylene blue or visualization of indocyanine green fluorescence was assessed on the staple line. In the ischemia group ICG was administered intravenously. On the 7th day after surgery, the histological material for morphology examination was collected. Results: In the group of SG with mechanical failure of staple line (n=11) positive ISG test was in 10 cases and positive methylene blue test was in 2 cases. In 90% of cases, ICG leakage corresponded to the localization of modeling ischemia zone, while methylene blue leakage was noted in only 20% of cases. Conclusions: The intraluminal administration of indocyanine green in cases of "mechanical" failure of staple line during sleeve gastrectomy is more informative compared to the standart methylene blue test. ICG angiography data fully corresponds to the localization of modeling ischemia zone.