Background

Insufficient blood flow has been hypothesized as a cause of leakage in bariatric surgery. Inadequate or decreased blood flow of the roux limb, the gastrojejunostomy, the angle of Hiss and the duodenal-ileostomy in bariatric operations can be assessed via Indocyanine Green flourescent imaging intraoperatively. We assessed the usefullness of Indocyanine green florescent blood flow imaging of these structures during Roux Y gastric bypass, duodenal switch and sleeve gastrectomy. Both primary and revisional procedures were studied.

Methods

50 consecutive patients undergoing primary or revisional Roux Y gastric bypass, vertical sleeve gastrectomy and duodenal switch operations were included in this study. 7.5 mg of ICG was injected intravenously followed by a 10cc saline bolus. For Roux Y gastric bypass the initial ICG bolus allowed evaluation of the Roux limb and the gastric pouch. A second bolus allowed evaluation of the final gastrojejunostomy. For sleeve gastrectomy a single bolus allowed evaluation of the entire vertical sleeve and in duodenal switch an initial bolus allowed evaluation of the transected duodenal stump. A second bolus allowed assessment of the duodenoileostomy.

Results

In three cases decreased or absent ICG blood flow was identified resulting in resection of a portion of the roux limb Decreased but adequate perfurion was seen in the duodenal stump of every duodenal switch. There were no leakages and no postoperative complication in the 50 cases studied.

Conclusions

Imunocyanine green fluorescent blood flow imaging may be useful for assessing anastomosis and staple lines in bariatric operations