The intraluminal administration of Indocyanine green as a method of intraoperative diagnostics of machine suture incompetence in experimental cases of longitudinal gastric resection

Abstract

BACKGROUND: Bariatric surgery represents an actively developing surgery field. With this, thanks to using modern automated methods of dissecting and suturing the tissues, a significant decrease is observed in the number of postoperative complications. At the same time, the problem of surgical suture incompetence remains topical even at the present times. The traditional methods of intraoperative diagnostics of incompetence are the provocative tests: the methylene blue test and the air leak test. One of the promising methods for intraoperative control during surgery is the use of fluorescent visualization in the near infrared range using the indocyanine green (ICG). AIM: Evaluate the informativity of intraoperative diagnostics of machine suture incompetence during the longitudinal gastric resection using fluorescent visualization with indocyanine green (ICG) by using the pig model to imitate various reasons of incompetence and to control surgical complications using morphological tests. METHODS: The research was carried out with using 20 pigs, each of which underwent the longitudinal gastric resection. The animals were distributed into the following experimental groups: the control group with performing standard longitudinal gastric resection (n=4) and the tests groups with longitudinal gastric resection and modeling of two variants of mechanical reasons of incompetence (n=12), as well as the local ischemia group (n=4). Intraoperationally, the gastric lumen was filled with a solution containing methylene blue and indocyanine green, after which, an evaluation was performed of the developed staining or Indocyanine green fluorescence visualization. Besides, in the ischemia group, ICG was administered intravenously. On Day 7 after surgery, samples were taken for histological examination. RESULTS: In 10 out of 11 experiments with the mechanical factor of modeling used to stimulate the machine suture incompetence, ICG visualization was found, with the ingress of methylene blue found in two cases out of 11, respectively. In 90% of the cases, the transudation of ICG corresponded to significant signs of inflammation, with the ingress of methylene blue being found only in 20% of the cases. CONCLUSION: The method of intraluminal administration of Indocyanine green in “mechanical” models of machine suture incompetence upon longitudinal gastric resection is more informative comparing to the introduction of methylene blue. Data from fluorescent ICG-angiography completely correspond to the location of ischemia modeling area.

Keywords

• bariatric surgery
• gastroplasty
• leak
• indocyanine green
• icg