title: Indocyanine green angiography for evaluation of gastric conduit perfusion during esophagectomy--first experience.
abstract: BACKGROUND
  A complication of esophageal surgery is leakage at the anastomosis site and one of the factors involved in this complication is poor blood flow in the distal portion of the tube. The aim of this study was to evaluate the feasibility of indocyanine green fluorescence imaging as a method of determining the perfusion of the gastric conduit after esophagectomy.
  
  
  METHODS
  We analysed 15 consecutive patients who underwent transhiatal esophagectomy (THE) due to cancer. All of the patients had reconstruction of the gastrointestinal tract using the gastric conduit. Before performing the anastomosis, the blood flow in the area of the tube was evaluated using intravenous indocyanine green and observing its vascular flow with a camera equipped with an infrared laser.
  
  
  RESULTS
  In all cases it was possible to visualize the vascular flow of indocyanine green within the region of the gastric tube. The fluorescence imaging system showed vascular insufficiency of the distal gastric conduit in 4 patients--in all of these patients the anastomosis was performed end-to-side and there was no subsequent leak. Leakage at the anastomosis site was observed in 1 patient (6.66%). The leak was observed in the 9th postoperative day, despite visualization of a good vascular supply of the tube.
  
  
  CONCLUSIONS
  Indocyanine green fluorescence imaging of gastric tube allows for intraoperative modifications, but it must be noted that the patient's comorbidities and general health may also increase the risk of anastomosis leakage.
authors.affiliation: 1st Department of Surgical Oncology and General Surgery, Greater Poland Cancer Center, Poznan, Poland.
authors.forename: D
authors.initials: D
authors.lastname: Murawa
authors.forename: M
authors.initials: M
authors.lastname: Hünerbein
authors.forename: A
authors.initials: A
authors.lastname: Spychała
authors.forename: P
authors.initials: P
authors.lastname: Nowaczyk
authors.forename: K
authors.initials: K
authors.lastname: Połom
authors.forename: P
authors.initials: P
authors.lastname: Murawa
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000503:physiopathology; D000792:Angiography; D004396:Coloring Agents; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green