ICG angiography in the safety of laparoscopic Roux-en-Y gastric bypass in bariatric patients

Khitaryan AG, Melnikov DA, Orekhov AA, et al. . ICG angiography in the safety of laparoscopic Roux-en-Y gastric bypass in bariatric patients. Russian Journal of Operative Surgery and Clinical Anatomy. 2022;6(3):35‑44. (In Russ.)
https://doi.org/10.17116/operhirurg2022603135

Подписка 2026 Оперативная хирургия и клиническая анатомия (Пироговский научный журнал) (Russian Journal of Operative Surgery and Clinical Anatomy)

Использование инфографики авторами научных работ

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OBJECTIVE

Assessment of blood supply and perfusion of the stomach stump according to ICG angiography during laparoscopic gastric bypass surgery with the formation of a small stomach stump.

MATERIAL AND METHODS

The results of laparoscopic gastric bypass surgery with a stomach stump with a volume of <25 ml and ICG angiography in 126 patients with morbid obesity were analyzed. The patients were divided into 3 groups according to the presence or absence of the posterior gastric artery (HFA) and its structure — the main type (group 1), the loose type (group 2), the absence of HFA (group 3). At the same time, patients with «intensive», «moderate» and «reduced» quality of blood supply to the stomach stump were identified in each group according to the rate of achieving adequate perfusion.

RESULTS

ICG angiography with chronometry revealed statistically significant differences in the «intensive» quality of blood supply to the stomach stump between the 1st and 2nd groups (p<0.001) and between the 1st and 3rd groups (p<0.001); with «reduced» quality of blood supply — between the 1st and groups 2 (p=0.021), between groups 1 and 3 of patients (p=0.002). At the same time, the time spent to achieve adequate perfusion of the posterior wall of the stomach stump relative to the anterior and the area of the Gis angle was less, which influenced the choice of the place of gastroenteroanastomosis.

CONCLUSION

Analysis of ICG angiography data with chronometry allowed to prove satisfactory blood supply to the small-sized stomach stump (<25 ml) in all the studied cases. When detecting a major type of heart disease, the intensity of blood supply to the stump in the area of the Gis angle and the anterior wall significantly decreases compared to the posterior wall of the stomach, which justifies the feasibility of creating a posterior gastroenteroanastomosis, preserving its medial branches and peritonization of the Gis angle. ICG angiography allows you to visualize intra-organ vessels, which makes it possible to choose a gastrotomy line in order to prevent bleeding from gastroenteroanastomosis.

Keywords:

laparoscopic gastroschunting

bariatrics

morbid obesity

posterior gastric artery

ICG angiography

Authors:

Khitaryan A.G.

Clinical Hospital «Russian Railway-Medicine» Rostov-on-Don;
Rostov State Medical University

SPIN RSCI: 2843-6943
Scopus AuthorID: 14823486300
ORCID: 0000-0002-2108-2362

Melnikov D.A.

Clinical Hospital “Russian Railway-Medicine”;
Rostov State Medical University

SPIN RSCI: 7823-3911
Scopus AuthorID: 57216864976
ORCID: 0000-0002-1829-3345

Orekhov A.A.

Clinical Hospital «Russian Railway-Medicine» Rostov-on-Don;
Rostov State Medical University

SPIN RSCI: 1717-9279
Scopus AuthorID: 8308950900
ResearcherID: E-5066-2016
ORCID: 0000-0002-7493-2121

Mezhunts A.V.

Clinical Hospital “Russian Railway-Medicine”;
Rostov State Medical University

SPIN RSCI: 4263-4090
Scopus AuthorID: 57204173300
ORCID: 0000-0001-7787-4919

Sarkisyan A.V.

Rostov State Medical University

ORCID: 0000-0002-6967-2556

Abovyan A.A.

Rostov State Medical University

SPIN RSCI: 1328-9619
ORCID: 0000-0002-3127-9935

Rogut A.A.

Clinical Hospital «Russian Railway-Medicine» Rostov-on-Don

ORCID: 0000-0002-0077-1273

Todorov S.S.

Rostov State Medical University

ORCID: 0000-0003-4787-4031

Received:

12.05.2022

Accepted:

15.06.2022

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