Combined endoscopic and laparoscopic real-time intra-operative evaluation of bowel perfusion using fluorescence angiography

Excerpt

Anastomotic leaks require reoperation in 95% of cases and result in significant mortality. More than half of all patients who experience an anastomotic leak will subsequently require a permanent stoma [1]. Thus, constructing a durable anastomosis remains paramount. Intra-operatively, the selection of an optimal site of bowel division in preparation for anastomosis has been dependent on subjective clinical indicators of intestinal viability. This includes, but is not limited to, characteristics including visual inspection of the bowel under white light, assessment of arterial vessel bleeding at the resected margin, and observed pulsation of mesenteric arterial inflow to the end organ [2]. While they are known to be multifactorial, one of the commonest explanations for anastomotic disruption and mal-healing is presumed to be associated with insufficient perfusion of the anastomosed segment [2‐4]. …