The Role of ICG During the SADI-S Procedure.

Abstract

Indocyanine green (ICG) is a nontoxic, fluorescent iodide dye with rapid hepatic clearance that has been used inmedical applications since the mid-1950s. In abdominal surgery, ICG can be used to identify anatomical structuressuch as the biliary tract, urinary tract, blood vessels, tissue perfusion on different organs, or anastomosis in thedigestive system. The application of ICG during bariatric surgery may be useful in primary and revisional proceduresat different steps of the surgery. The purpose of this study is to examine the role of indocyanine green during theSADI-S procedure and to highlight the key aspects of this procedure. We present a case series of 22 patients withmorbid obesity who underwent a multidisciplinary evaluation and were selected for the SADI-S procedure via alaparoscopic approach. The ICG dose and timing were as recommended in the International Society for FluorescenceGuided Surgery guidelines. For arteriography, 3 ml (7.5 mg) was used, and the detection time was 30-60 s after intravenous administration. For visualization of the common bile duct, we used 1 ml (2.5 mg) appliedintravenously at least 45 min before the procedure. For the leak test, a dilution of 1 ml (2.5 mg) of ICG + 5 ml ofmethylene blue in 100 cc of sterile water, which was prepared just before the test, was used, and the mixture waspassed through an orogastric tube. We expose the surgical steps in which ICG can improve outcomes or preventcomplications when performing the SADI-S procedure. Key Points • The role of ICG during SADI-S is described. • The step-by-step results of ICG during the SADI-S procedure are highlighted. • ICG was shown to be safe and useful during bariatric surgery in morbidly obese patients.