[Indocyanine green angiography of gastric stump in primary and secondary bariatric surgeries].

OBJECTIVE

To study and compare tissue perfusion as measured by ICG angiography in bariatric patients during primary and revision surgeries.

MATERIAL AND

METHODS

A retrospective cohort study was conducted, comprising an analysis of medical histories and videotaped surgical procedures performed on 112 patients. The patients were divided into two groups for the purposes of analysis. Group 1 (69 cases, 61.6%) comprised patients who had undergone a primary one-anastomosis gastric bypass (OAGB) and a primary Roux-en-Y gastric bypass (RYGB). Group 2 (43 cases, 38.4%) consisted of patients who had undergone a revision MGB/OAGB and a revision RYGB. Intraoperative ICG angiography was conducted on all patients.

RESULTS

Tissue perfusion was evaluated at two distinct locations: the area of the Gis angle and the distal portion of the gastric stump within the region of the gastrotomy orifice. In addition to the qualitative analysis, a quantitative analysis was also conducted in the identified risk areas. This involved the use of chronometry, which enables the precise determination of the intensity of the blood supply and the necessity for further actions to guarantee the safety of the surgical procedure. Consequently, two patients in the second group, namely those undergoing revision OAGB, exhibited a decline in blood supply, manifesting as «reduced» perfusion. This necessitated the excision of the stomach stump 2 cm proximally to guarantee the safety of the procedure.

CONCLUSION

The failure of the stapler suture line and gastroenteroanastomosis following bariatric surgeries can result in life-threatening complications. One of the most promising and thoroughly described methods of intraoperative assessment of the quality of blood supply and perfusion of the gastric stump is indocyanine green (ICG) angiography. A decrease in perfusion in the area of the Gis angle is observed in almost no patients who have undergone revision surgeries. This appears to be associated with a long period of adaptation following the primary surgery and the development of collaterals. In light of the aforementioned considerations, it is recommended that patients with a comorbid background (e.g., steatohepatosis, type 2 diabetes mellitus, atherosclerosis) undergo RYGB rather than OAGB. This approach will ensure more intensive perfusion of the stomach stump and the area of gastroenteroanastomosis, thereby reducing the risk of ischemic complications.