USE OF ICG IN BARIATRIC SURGERY, DOES IT MAKE THE DIFFERENCE? alarcon@egocenter.mx

441-06

USE OF ICG IN BARIATRIC SURGERY, DOES IT MAKE THE DIFFERENCE?

6

Mexico

Video

Bariatric surgery is the established treatment for obesity and its comorbidities, providing long-term weight loss and improved survival. Benefits include enhanced quality of life and reduced incidence of diabetes and hypertension. Staple line leakage after bariatric surgery is a feared complication, associated with sepsis, multiorgan failure, enterocutaneous fistulas, and mortality. Intraoperative methods to assess anastomotic integrity include methylene blue injection, endoscopic insufflation, and more recently, intraluminal indocyanine green (ICG) administration.

A 32-year-old female with type 2 diabetes (4 years) and BMI 32 kg/m² underwent Roux-en-Y gastric bypass using a 4K Hypixel Mindray laparoscopic tower. A gastric pouch was created over a 40 Fr bougie, followed by gastrojejunostomy and jejunojejunostomy with a 45 mm articulating stapler. Leak testing was performed with 3 mL ICG (25 mg in 60 mL saline) intraluminally, revealing posterior gastrojejunostomy extravasation. A subsequent 50 mL methylene blue test confirmed leakage at the same site. The defect was repaired with continuous 2-0 Monocryl sutures, and post-repair leak tests were negative.

The patient tolerated the procedure without complications, initiated a liquid diet 8 hours postoperatively, and was discharged 24 hours after surgery.

Intraluminal ICG leak testing provides a clear, highly visible fluorescence for defect localization, with the advantage of switching to standard illumination for direct visualization. Compared to methylene blue or endoscopic insufflation, ICG offers precise identification without increasing operative time or costs. This case demonstrates its feasibility and utility in bariatric surgery leak assessment.

https://vimeo.com/1116850401/2daa79d685