TY - JOUR
T1 - The use of fluorescence angiography to assess bowel viability in the acute setting
T2 - an international, multi-centre case series
AU - Joosten, Johanna J.
AU - Longchamp, Grégoire
AU - Khan, Mohammad F.
AU - Lameris, Wytze
AU - van Berge Henegouwen, Mark I.
AU - Bemelman, Wilhelmus A.
AU - Cahill, Ronan A.
AU - Hompes, Roel
AU - Ris, Frédéric
N1 - Funding Information: Prof. Dr. M. I. van Berge Henegouwen: unrestricted grants from Olympus and Stryker and consultancy for Johnson and Johnson Alesi, Surgical, Mylan, Braun, and Medtronic. All fees and grants paid to institution. Prof. Dr. W. A. Bemelman: speaker fees from Johnson & Johnson, Medtronic, Takeda, consulting fees from Takeda and Braun. Prof. Dr. R. Cahill; speaker fees from Stryker Corp, Olympus and Ethicon/J&J, research funding from Intuitive Corp and Medtronic and from the Irish Government (DTIF) in collaboration with IBM Research in Ireland and from EU Horizon 2020 in collaboration with Palliare. Dr. R. Hompes: unrestricted grant and materials Stryker European Operations B.V. Prof. Dr. F. Ris: Research grant from Quantgene and Johnson & Johnson, consulting for Arthrex, Distal Motion, Hollister, Freka, and Stryker. Dr. J. J. Joosten, Dr. W. Lameris, Dr. G. Longchamp, and Dr. M. F. Khan have no conflict or financial ties to disclose. Publisher Copyright: © 2022, The Author(s).
PY - 2022/10
Y1 - 2022/10
N2 - Introduction: Assessing bowel viability can be challenging during acute surgical procedures, especially regarding mesenteric ischaemia. Intraoperative fluorescence angiography (FA) may be a valuable tool for the surgeon to determine whether bowel resection is necessary and to define the most appropriate resection margins. The aim of this study is to report on FA use in the acute setting and to judge its impact on intraoperative decision making. Materials and methods: This is a multi-centre, retrospective case series of patients undergoing emergency abdominal surgery between February 2016 and 2021 in three general/colorectal units where intraoperative FA was performed to assess bowel viability. Primary endpoint was change of management after the FA assessment. Results: A total of 93 patients (50 males, 66.6 ± 19.2 years, ASA score ≥ III in 85%) were identified and studied. Initial surgical approach was laparotomy in 66 (71%) patients and laparoscopy in 27 (29% and seven, 26% conversions). The most common aetiologies were mesenteric ischaemia (n = 42, 45%) and adhesional/herniae-related strangulation (n = 41, 44%). In 50 patients a bowel resection was performed. Overall rates of anastomosis after resection, reoperation and 30-day mortality were 48% (n = 24/50, one leak), 12% and 18%, respectively. FA changed management in 27 (29%) patients. In four patients (4% overall), resection was avoided and in 21 (23%) extra bowel length was preserved (median 50 cm of bowel saved, IQR 28–98) although three patients developed further ischaemia. FA prompted extended resection (median of 20 cm, IQR 10–50 extra bowel) in six (6%) patients. Conclusion: Intraoperative use of FA impacts surgical decisions regarding bowel resection for intestinal ischaemia, potentially enabling bowel preservation in approximately one out of four patients. Prospective studies are needed to optimize the best use of this technology for this indication and to determine standards for the interpretation of FA images and the potential subsequent need for second-look surgeries.
AB - Introduction: Assessing bowel viability can be challenging during acute surgical procedures, especially regarding mesenteric ischaemia. Intraoperative fluorescence angiography (FA) may be a valuable tool for the surgeon to determine whether bowel resection is necessary and to define the most appropriate resection margins. The aim of this study is to report on FA use in the acute setting and to judge its impact on intraoperative decision making. Materials and methods: This is a multi-centre, retrospective case series of patients undergoing emergency abdominal surgery between February 2016 and 2021 in three general/colorectal units where intraoperative FA was performed to assess bowel viability. Primary endpoint was change of management after the FA assessment. Results: A total of 93 patients (50 males, 66.6 ± 19.2 years, ASA score ≥ III in 85%) were identified and studied. Initial surgical approach was laparotomy in 66 (71%) patients and laparoscopy in 27 (29% and seven, 26% conversions). The most common aetiologies were mesenteric ischaemia (n = 42, 45%) and adhesional/herniae-related strangulation (n = 41, 44%). In 50 patients a bowel resection was performed. Overall rates of anastomosis after resection, reoperation and 30-day mortality were 48% (n = 24/50, one leak), 12% and 18%, respectively. FA changed management in 27 (29%) patients. In four patients (4% overall), resection was avoided and in 21 (23%) extra bowel length was preserved (median 50 cm of bowel saved, IQR 28–98) although three patients developed further ischaemia. FA prompted extended resection (median of 20 cm, IQR 10–50 extra bowel) in six (6%) patients. Conclusion: Intraoperative use of FA impacts surgical decisions regarding bowel resection for intestinal ischaemia, potentially enabling bowel preservation in approximately one out of four patients. Prospective studies are needed to optimize the best use of this technology for this indication and to determine standards for the interpretation of FA images and the potential subsequent need for second-look surgeries.
KW - Acute setting
KW - Case series
KW - Change of management
KW - Fluorescence angiography
KW - Ischaemia
UR - http://www.scopus.com/inward/record.url?scp=85125037925&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00464-022-09136-7
DO - https://doi.org/10.1007/s00464-022-09136-7
M3 - Article
C2 - 35199204
SN - 0930-2794
VL - 36
SP - 7369
EP - 7375
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 10
ER -