Fluorescence-based bowel anastomosis perfusion evaluation: results from the IHU-IRCAD-EAES EURO-FIGS registry

BACKGROUND

Anastomotic leakage (AL) is one of the dreaded complications following surgery in the digestive tract. Near-infrared fluorescence (NIRF) imaging is a means to intraoperatively visualize anastomotic perfusion, facilitating fluorescence image-guided surgery (FIGS) with the purpose to reduce the incidence of AL. The aim of this study was to analyze the current practices and results of NIRF imaging of the anastomosis in digestive tract surgery through the EURO-FIGS registry.

METHODS

Analysis of data prospectively collected by the registry members provided patient and procedural data along with the ICG dose, timing, and consequences of NIRF imaging. Among the included upper-GI, colorectal, and bariatric surgeries, subgroup analysis was performed to identify risk factors associated with complications.

RESULTS

A total of 1240 patients were included in the study. The included patients, 74.8% of whom were operated on for cancer, originated from 8 European countries and 30 hospitals. A total of 54 surgeons performed the procedures. In 83.8% of cases, a pre-anastomotic ICG dose was administered, and in 60.1% of cases, a post-anastomotic ICG dose was administered. A significant difference (p < 0.001) was found in the ICG dose given in the four pathology groups registered (range: 0.013-0.89 mg/kg) and a significant (p < 0.001) negative correlation was found between the ICG dose and BMI. In 27.3% of the procedures, the choice of the anastomotic level was guided by means of NIRF imaging which means that in these cases NIRF imaging changed the level of anastomosis which was first decided based on visual findings in conventional white light imaging. In 98.7% of the procedures, the use of ICG partly or strongly provided a sense of confidence about the anastomosis. A total of 133 complications occurred, without any statistical significance in the incidence of complications in the anastomoses, whether they were ICG-guided or not.

CONCLUSION

The EURO-FIGS registry provides an insight into the current clinical practice across Europe with respect to NIRF imaging of anastomotic perfusion during digestive tract surgery.

An unexpected death after low anterior resection due to disseminated intravascular coagulation: A case report

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Disseminated intravascular coagulation can develop due to unrecognized sepsis.

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It can have a life-threatening course even in young, previously healthy patients.

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Rotational thromboelastometry may aid in guiding the treatment.

Introduction

Disseminated intravascular coagulation (DIC) is a blood clotting disorder that is characterized by intravascular thrombi formation and exhaustion of platelets and coagulation factors resulting in diffuse hemorrhage and multiple organ dysfunction.

Presentation of case

We present a case report of a previously healthy middle-aged patient who was treated by low anterior resection for rectal carcinoma and suddenly went into unexpected circulatory shock on the 7th postoperative day. Despite our resuscitation efforts, he succumbed to the disease. The postmortem examination showed findings consistent with DIC.

Discussion

The cause for DIC in this patient may be multifactorial. Sepsis, tumor-related factors and hereditary predisposition may have played a role. The role of blood components in treatment is not fully understood as they may worsen the inflammatory response.

Conclusion

DIC can be the presenting sign of unrecognized sepsis and it can occur in all surgical patients. Even with prompt treatment, the disease can have a fatal course.