Qualitative ICG Imaging to Assess Rectal Anastomotic Perfusion in Deep Infiltrating Endometriosis Surgery

Abstract

Study Objective To present a practical approach to assess bowel perfusion at anastomotic site using ICG Imaging during Deep Infiltrating Endometriosis (DIE) surgery. Design Case report. Setting OR. Use of ICG imaging after segmental resection for DIE. Test results prompted a second resection/Anastomosis. Patients or Participants 43-year-old-woman, G1P1A0, Partial right oophorectomy (open surgery), 8 years before. Seven years of progressive dysmenorrhea (8/10), dyspareunia (7/10) and Dyschezia (9/10) with occasional hematochezia. After imaging and colonoscopy, posterior compartment and biparametrial DIE was diagnosed, including a 4 cm rectal nodule with submucosal involvement. Interventions Video shows surgical procedure in which after colorectal anastomosis, there was a vascular impairment detected by ICG imaging, that prompted the team to perform a further colonic resection with a new anastomosis. Measurements and Main Results Uneventful postoperative course. Discharged on POD 3. No bladder voiding or defecatory disfunctions. After two years follow up the symptoms have not reappeared. Conclusion ICG imaging, in the context of colorectal anastomosis, is a valuable tool which probably reduces the rate of anastomotic leakage detecting microvascular impairment in the anastomotic site. To present a practical approach to assess bowel perfusion at anastomotic site using ICG Imaging during Deep Infiltrating Endometriosis (DIE) surgery. Case report. OR. Use of ICG imaging after segmental resection for DIE. Test results prompted a second resection/Anastomosis. 43-year-old-woman, G1P1A0, Partial right oophorectomy (open surgery), 8 years before. Seven years of progressive dysmenorrhea (8/10), dyspareunia (7/10) and Dyschezia (9/10) with occasional hematochezia. After imaging and colonoscopy, posterior compartment and biparametrial DIE was diagnosed, including a 4 cm rectal nodule with submucosal involvement. Video shows surgical procedure in which after colorectal anastomosis, there was a vascular impairment detected by ICG imaging, that prompted the team to perform a further colonic resection with a new anastomosis. Uneventful postoperative course. Discharged on POD 3. No bladder voiding or defecatory disfunctions. After two years follow up the symptoms have not reappeared. ICG imaging, in the context of colorectal anastomosis, is a valuable tool which probably reduces the rate of anastomotic leakage detecting microvascular impairment in the anastomotic site.