OBJECTIVE

To refine the technique of video fluorescence angiography with indocyanine green (VFA-ICG) for assessing tissue perfusion in intestinal anastomoses in patients with gunshot wounds to the small intestine and to identify a reliable criterion for predicting anastomotic suture failure.

MATERIALS AND METHODS

A retrospective analysis was performed of treatment outcomes in 66 patients with gunshot wounds to the small intestine who, during staged surgical management, underwent creation of intestinal anastomoses and laparostomy; intraoperatively, a modified VFA-ICG protocol was used with quantitative perfusion assessment and calculation of a fluorescence index, defined as the ratio of the maximum brightness of anastomotic tissues to that of the corresponding intact small-bowel segment. A logistic regression model was constructed, followed by receiver operating characteristic (ROC) analysis, to determine the diagnostic value of the fluorescence index and threshold values associated with the risk of anastomotic leakage.

RESULTS

Logistic regression analysis demonstrated that the fluorescence index is an independent predictor of anastomotic suture failure (B=–28.1; OR 6.15·10^–13; 95% CI 2.0·10^–20—1.88·10^–5; p=0.001). ROC analysis identified a fluorescence index threshold of 0.69, below which the probability of anastomotic leakage increases significantly (AUC 0.975; sensitivity 91.7%; specificity 96.3%), which enabled the development of a risk stratification scale and an algorithm for selecting the extent of surgical intervention (anastomotic reinforcement, creation of a diverting enterostomy, and determining optimal timing of laparostomy closure).

CONCLUSION

Intraoperative VFA-ICG with quantitative perfusion assessment using the fluorescence index is a reliable tool for predicting intestinal anastomotic suture failure in gunshot wounds to the small intestine and supports optimization of surgical strategy, reduction of specific intra-abdominal infectious complications and mortality, and lowering of treatment costs in this patient population.