The Use of Near-Infrared Fluorescence in Sleeve Gastrectomy

Abstract

Obesity is the most prevalent chronic disease in the United States and bariatric surgery stands as the best treatment. Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric operation performed in the United States. Leaks after LSG are rare but represent the most serious complication. The majority of leaks occur in the proximal third of the stomach near the angle of His, and ischemia is the most likely etiology. Indocyanine green (ICG) is an ideal compound to assess tissue perfusion intraoperatively, and ICG fluorescence angiography during LSG can be used to identify blood supply patterns. Confirming adequate perfusion of the remnant sleeve stomach minimizes perfusion compromise and prevents potential serious postoperative complications including leaks and strictures. ICG can also be used in anastomotic operations such as gastric bypass and biliopancreatic diversion with duodenal switch with many potential future applications.