Perfusion visualization during ileal J-pouch formation

• Verfasst von: Lobbes, Leonard Aziz [VerfasserIn]
• Verfasst von: Berns, Susanne [VerfasserIn]
• Verfasst von: Warschkow, René [VerfasserIn]
• Verfasst von: Schmidt, Leonard R. [VerfasserIn]
• Verfasst von: Schineis, Christian [VerfasserIn]
• Verfasst von: Strobel, Rahel M. [VerfasserIn]
• Verfasst von: Lauscher, Johannes C. [VerfasserIn]
• Verfasst von: Beyer, Katharina [VerfasserIn]
• Verfasst von: Weixler, Benjamin [VerfasserIn]
• Titel: Perfusion visualization during ileal J-pouch formation
• Titelzusatz: a proposal for the standardization of intraoperative imaging with indocyanine green near-infrared fluorescence and a postoperative follow-up in IBD surgery
• Verf.angabe: Leonard A. Lobbes, Susanne Berns, René Warschkow, Leonard R. Schmidt, Christian Schineis, Rahel M. Strobel, Johannes C. Lauscher, Katharina Beyer and Benjamin Weixler
• E-Jahr: 2022
• Jahr: 30 April 2022
• Umfang: 14 S.
• Fussnoten: Gesehen am 14.07.2022 ; This article belongs to the special issue "New insights into the diagnosis and treatment of inflammatory bowel diseases"
• Titel Quelle: Enthalten in: Life
• Ort Quelle: Basel : MDPI, 2011
• Jahr Quelle: 2022
• Band/Heft Quelle: 12(2022), 5, special issue, Artikel-ID 668, Seite 1-14
• ISSN Quelle: 2075-1729
• DOI: doi:10.3390/life12050668
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: anastomotic leak
• Sach-SW: ileal J-pouch
• Sach-SW: indocyanine green (ICG) near-infrared fluorescence
• Sach-SW: perfusion visualization
• Sach-SW: ulcerative colitis
• K10plus-PPN: 1810187478

Abstract

Background: An anastomotic leak (AL) after a restorative proctocolectomy and an ileal J-pouch increases morbidity and the risk of pouch failure. Thus, a perfusion assessment during J-pouch formation is crucial. While indocyanine green near-infrared fluorescence (ICG-NIRF) has shown potential to reduce ALs, its suitability in a restorative proctocolectomy remains unclear. We aimed to develop a standardized approach for investigating ICG-NIRF and ALs in pouch surgery. Methods: Patients undergoing a restorative proctocolectomy with an ileal J-pouch for ulcerative colitis at an IBD-referral-center were included in a prospective study in which an AL within 30 postoperative days was the primary outcome. Intraoperatively, standardized perfusion visualization with ICG-NIRF was performed and video recorded for postoperative analysis at three time points. Quantitative clinical and technical variables (secondary outcome) were correlated with the primary outcome by descriptive analysis and logistic regression. A novel definition and grading of AL of the J-pouch was applied. A postoperative pouchoscopy was routinely performed to screen for AL. Results: Intraoperative ICG-NIRF-visualization and its postoperative visual analysis in 25 patients did not indicate an AL. The anastomotic site after pouch formation appeared completely fluorescent with a strong fluorescence signal (category 2) in all cases of ALs (4 of 25). Anastomotic site was not changed. ICG-NIRF visualization was reproducible and standardized. Logistic regression identified a two-stage approach vs. a three-stage approach (Odds ratio (OR) = 20.00, 95% confidence interval [CI] = 1.37-580.18, p = 0.029) as a risk factor for ALs. Conclusion: We present a standardized, comparable approach of ICG-NIRF visualization in pouch surgery. Our data indicate that the visual interpretation of ICG-NIRF alone may not detect ALs of the pouch in all cases—quantifiable, objective methods of interpretation may be required in the future.