Intraoperative Indocyanine Green Fluorescence Angiography for Assessing Intestinal Perfusion in Infants with Necrotizing Enterocolitis-Associated Colonic Strictures: A Retrospective Comparative Study.

OBJECTIVE

To evaluate the clinical utility and safety of indocyanine green fluorescence angiography (ICG-FA) during surgery for necrotizing enterocolitis (NEC)-associated colonic strictures in infants, with particular attention to intraoperative decision-making and anastomotic leakage (AL).

METHODS

This retrospective comparative cohort study, conducted in accordance with the STROBE guidelines, included 108 infants who underwent intestinal resection and primary anastomosis for NEC-associated colonic strictures between 2022 and 2024. Patients were classified into an ICG-FA group (n = 45) and a non-ICG group (n = 63) according to whether intraoperative fluorescence angiography was used. Baseline characteristics, operative variables, and postoperative outcomes were compared. The primary endpoint was AL; secondary endpoints included ICG-guided surgical plan modification, perioperative recovery, and overall morbidity. Statistical significance was defined as P < .05.

RESULTS

Baseline characteristics were comparable between the two groups. ICG-FA prompted modification of the planned resection margin in 5 of 45 patients (11.11%), whereas no comparable modification was documented in the non-ICG group (P = .035). The median time to adequate fluorescence visualization was 20 seconds, and no ICG-related adverse events occurred. AL was observed in one patient in the non-ICG group (1.59%) and in no patients in the ICG-FA group; however, this difference was not statistically significant (P = .395). Other postoperative complications and overall morbidity were similar between groups. During a median follow-up of 15 months, all complications resolved with conservative treatment or secondary intervention.

CONCLUSION

ICG-FA is a safe and feasible adjunct for real-time assessment of intestinal perfusion in infants with NEC-associated colonic strictures. Although this study was not powered to demonstrate a statistically significant reduction in AL, ICG-FA helped identify potentially underperfused margins and supported individualized resection planning. Larger prospective studies with standardized fluorescence assessment are required to confirm its effect on anastomotic outcomes.