Intraoperative NIR-II fluorescence imaging for assessment of bowel vascular morphology and inflammatory severity in Hirschsprung's disease.

PURPOSE: To evaluate the feasibility of near-infrared II (NIR-II) fluorescence imaging for intraoperative assessment of vascular morphology and inflammatory severity at the planned anastomotic site in children with Hirschsprung's disease (HD).

METHODS

Seventeen children with HD underwent intraoperative indocyanine green fluorescence angiography during pull-through surgery. Capillary phantom experiments were performed to compare near-infrared I (NIR-I) and NIR-II imaging. Signal-to-background ratio (SBR), vessel delineation, and the association between fluorescence findings and histopathologic inflammatory grade were analyzed. Postoperative outcomes were explored in patients with complete follow-up.

RESULTS

NIR-II imaging provided clearer visualization of arteries, veins, and deeper microvasculature than NIR-I, with a significantly higher SBR. NIR-II SBR was associated with histopathologic inflammatory grade, and an SBR < 1.17 was associated with severe mucosal inflammation. Long-term follow-up was available for 10 patients (40-66 months). Patients with less favorable postoperative outcomes showed numerically lower NIR-II SBR values, but these differences were not statistically significant.

CONCLUSION

NIR-II fluorescence imaging improves intraoperative vascular visualization and shows promise for assessing inflammatory severity in HD. Its association with postoperative outcomes remains exploratory and requires validation in larger prospective studies.