Fluorescence angiography decreases the risk of colorectal an
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There are important consequences for anastomotic leaks following colorectal anastomoses, including increased morbidity, prolonged hospitalization, and decreased overall survival. The reasons behind this can be patient related, technical factors, and anastomotic perfusion. An intact anastomotic blood flow is crucial in anastomotic healing. The use of indocyanine green fluorescence angiography is associated with a decrease in anastomotic leakage. It helps in visualizing vascular perfusion at the anastomotic site and can help surgeons decide the viability of the anastomosis.

The systemic review and meta-analysis published in the journal of Surgery was purposed to evaluate the efficacy of indocyanine green fluorescence angiography in decreasing anastomotic leakage.

For the study design, PubMed, Web of Science, Embase, and the Cochrane Library were searched to identify studies comparing the use of indocyanine green fluorescence angiography versus standard care on rates of anastomotic leakage. Data were pooled with the Mantel-Haenszel method and analyzed based on a random-effects model to estimate the pooled odds ratio and 95% confidence interval. The heterogeneity of studies was evaluated using I2 statistics.

Twenty studies were included in this meta-analysis of 5,498 patients. The pooled estimate of the odds ratio was 0.46 (95% confidence interval 0.34–0.62; P < .00001) favoring indocyanine green fluorescence angiography. The overall anastomotic leak rate was 3.7% in the intervention group and 8.6% in the control group. Indocyanine green fluorescence angiography led to a change in the anastomotic site in 216 patients.

Subgroup analyses of anastomotic leakage requiring intervention, patients requiring a low colorectal anastomosis, and prospective studies had a pooled estimate of odds ratio 0.55, odds ratio 0.38, and odds ratio 0.49 respectively.

In conclusion, the use of indocyanine green fluorescence angiography is associated with a decrease in anastomotic leakage. This association is present in patients with severe anastomotic leakage requiring intervention as well as low colorectal anastomoses.

Source: https://doi.org/10.1016/j.surg.2020.08.024
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