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Khitaryan A.G.

Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don»;
Rostov State Medical University

Melnikov D.A.

Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don»;
Rostov State Medical University

Mezhunts A.V.

Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don»;
Rostov State Medical University

Rogut A.A.

Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don»

Pen O.S.

Rostov State Medical University

Pukovskiy D.Yu.

Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don»

ICG angiography is a safety standard in bariatric surgery

Authors:

Khitaryan A.G., Melnikov D.A., Mezhunts A.V., Rogut A.A., Pen O.S., Pukovskiy D.Yu.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2024;(7): 115‑123

DOI: 10.17116/hirurgia2024071115

Views: 491

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Table of contents

To cite this article:

Khitaryan AG, Melnikov DA, Mezhunts AV, Rogut AA, Pen OS, Pukovskiy DYu. ICG angiography is a safety standard in bariatric surgery. Pirogov Russian Journal of Surgery. 2024;(7):115‑123. (In Russ.)
https://doi.org/10.17116/hirurgia2024071115

Подписка 2025 (Pirogov Russian Journal of Surgery)
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OBJECTIVE

To examine the specific characteristics of ICG-angiography during various bariatric interventions.

MATERIAL AND METHODS

The study included 329 patients, with 105 (32%) undergoing sleeve gastrectomy (LSG), 98 (30%) undergoing mini-gastricbypass (MGB), 126 (38%) undergoing Roux-en-Y gastric bypass (RGB). Intraoperative ICG angiography was perfomed on all patients at ‘control points’, the perfusion of the gastric stump was qualitatively and quantitatively assessed.

RESULTS

Intraoperative ICG angiography shows that during LSG the angioarchitectonics in the area of the His angle are crucial. The presence of the posterior gastric artery of the gastric main type is a prognostically unfavorable risk factor for the development of ischemic complications. Therefore, to expand the gastric stump it is necessary to suture a 40Fr nasogastric tube and perform peritonization of the staple line. Statistical difference in blood supply at three points were found between and within the two groups of patients (Gis angle area, gastric body, pyloric region) with a p-value <0.001. During MGB, one of the important stages is applying the first (transverse) stapler cassette between the branches of the right and left gastric arteries. This maintains blood supply in anastomosis area, preventing immediate complications such as GEA failure, as well as long-term complications like atrophic gastritis, peptic ulcers, and GEA stenosis.

CONCLUSION

ICG angiography is a useful method for intraoperative assessment of angioarchitecture and perfusion of the gastric stump during bariatric surgery. This helps prevent tissue ischemia and reduce the risk of early and late postoperative complications.

Keywords:

sleeve gastrectomy
mini-gastric bypass
Roun-en-Y gastric bypass
bariatric surgery
morbid obesity
Indocyanine green angiography
ICG
Perfusion

Authors:

Khitaryan A.G.

Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don»;
Rostov State Medical University

Melnikov D.A.

Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don»;
Rostov State Medical University

Mezhunts A.V.

Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don»;
Rostov State Medical University

Rogut A.A.

Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don»

Pen O.S.

Rostov State Medical University

Pukovskiy D.Yu.

Private healthcare institution «Clinical Hospital» Russian Railways-Medicine «Rostov-on-Don»

Received:

01.04.2024

Accepted:

25.04.2024

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