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The Use of Fluorescence Angiography During Laparoscopic Sleeve Gastrectomy.

Publication ,  Journal Article
Ortega, CB; Guerron, AD; Yoo, JS
Published in: JSLS
2018

BACKGROUND AND OBJECTIVES: A new technology involving indocyanine green (ICG) fluorescence angiography has been introduced to assess tissue perfusion and perform vascular mapping during laparoscopic surgery. The purpose of this study was to describe the use of this technology to identify the variable blood supply patterns to the stomach and gastroesophageal (GE) junction during laparoscopic sleeve gastrectomy (LSG), which may help in preserving the blood supply and preventing ischemia-related leaks. METHODS: Eighty-six patients underwent LSG and were examined intraoperatively with fluorescence angiography at an academic bariatric center from January 2016 to September 2017. Before the construction of the SG, 1 mL ICG was injected intravenously, and near infrared fluorescence imaging technology was used to identify the blood supply of the stomach. Afterward, the LSG was created with attention to preserving the identified blood supply to the GE junction and gastric tube. Finally, 3 mL ICG was injected to ensure that all the pertinent blood vessels were preserved. RESULTS: Eighty-six patients successfully underwent the laparoscopic procedure with no complications. The following patterns of blood supply to the GE junction were found: (1) a right-side-dominant pattern (20%), arising from the left gastric artery; (2) a right-side-accessory pattern (36%), running in the gastrohepatic ligament and comprising either an accessory hepatic artery or an accessory gastric artery; and (3) a left-side accessory pattern arising from tributaries from the left inferior phrenic artery significantly contributing to the right-side blood supply. In addition, in 10% of the cases both right and left accessory patterns were present simultaneously. CONCLUSION: ICG fluorescence angiography allows determination of the major blood supply to the proximal stomach before any dissection during sleeve gastrectomy, so that an effort can be made to avoid unnecessary injury to these vessels during the procedure.

Duke Scholars

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Published In

JSLS

DOI

EISSN

1938-3797

Publication Date

2018

Volume

22

Issue

2

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Stomach
  • Obesity, Morbid
  • Laparoscopy
  • Humans
  • Gastrectomy
  • Fluorescein Angiography
  • Esophagogastric Junction
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ortega, C. B., Guerron, A. D., & Yoo, J. S. (2018). The Use of Fluorescence Angiography During Laparoscopic Sleeve Gastrectomy. JSLS, 22(2). https://doi.org/10.4293/JSLS.2018.00005
Ortega, Camila B., Alfredo D. Guerron, and Jin S. Yoo. “The Use of Fluorescence Angiography During Laparoscopic Sleeve Gastrectomy.JSLS 22, no. 2 (2018). https://doi.org/10.4293/JSLS.2018.00005.
Ortega, Camila B., et al. “The Use of Fluorescence Angiography During Laparoscopic Sleeve Gastrectomy.JSLS, vol. 22, no. 2, 2018. Pubmed, doi:10.4293/JSLS.2018.00005.

Published In

JSLS

DOI

EISSN

1938-3797

Publication Date

2018

Volume

22

Issue

2

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Stomach
  • Obesity, Morbid
  • Laparoscopy
  • Humans
  • Gastrectomy
  • Fluorescein Angiography
  • Esophagogastric Junction
  • 3202 Clinical sciences