ICG Fluorescence Angiography to Reduce Anastomotic Leak After Laparoscopic Colorectal Resection

September 13, 2026 updated by: Alexandria University

Effect of Indocyanine Green Fluorescence Angiography on Anastomotic Leak After Elective Laparoscopic Colorectal Resection: A Prospective Randomized Controlled Trial

This prospective randomized controlled trial evaluates whether intraoperative indocyanine green (ICG) fluorescence angiography reduces clinically significant anastomotic leakage after elective laparoscopic colorectal resection with primary anastomosis. A total of 120 adults were allocated in a 1:1 ratio to ICG-guided perfusion assessment or standard visual perfusion assessment, with 60 participants in each group. In the ICG arm, ICG 0.2 mg/kg was administered intravenously after bowel mobilization and before transection, and near-infrared imaging guided selection of a well-perfused transection margin. Participants were followed for 90 days after surgery for grade B or C anastomotic leakage.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Adequate perfusion is essential for colorectal anastomotic healing. Standard intraoperative assessment relies on bowel color, mesenteric pulsation, and bleeding from the cut edge. ICG fluorescence angiography provides real-time near-infrared visualization of bowel perfusion and may identify inadequately perfused segments before anastomosis.

Eligible participants undergoing elective laparoscopic colorectal resection with planned primary anastomosis were randomized using closed-envelope allocation. In the experimental arm, fluorescence was evaluated using a standardized ordinal score: 0, no fluorescence within 60 seconds; 1, delayed or patchy fluorescence at 60 seconds; 2, reduced but homogeneous fluorescence within 30-60 seconds; and 3, rapid homogeneous fluorescence within 30 seconds. Time to fluorescence was recorded at a defined region of interest, and transection was performed at an area showing grade 3 perfusion. In the comparator arm, transection and anastomosis proceeded using standard visual assessment without ICG.

Postoperative evaluation included clinical surveillance. Contrast-enhanced computed tomography of the abdomen and pelvis was obtained when clinically indicated. Clinically significant anastomotic leakage was defined as grade B or C leakage within 90 days and confirmed by clinical findings, contrast imaging, or reoperation.

Study Type

Interventional

Enrollment (Actual)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
      • Alexandria, Egypt
        • Alexandria Main University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adults aged 18 years or older.
  • Undergoing elective laparoscopic colorectal resection.
  • Planned primary colorectal anastomosis.
  • Able and willing to provide written informed consent.

Exclusion Criteria:

  • Known allergy to iodine or indocyanine green.
  • Severe hepatic dysfunction.
  • Severe renal dysfunction.
  • Emergency colorectal resection.
  • Inflammatory bowel disease requiring extensive resection.
  • Previous colorectal surgery involving the planned anastomotic site.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: ICG Fluorescence Angiography
Assess the blood supply using icg
Other: Visual assessment
Visual assessment
Active Comparator: Standard Visual Perfusion Assessment
Immediate visual assessment for colon blood supply
Diagnostic test: ICG visuals assessment
Injection of ICG and visually asses vascularity

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of clinically significant anastomotic leakage
Time Frame: 90 days after surgery
Incidence of clinically significant anastomotic leakage, defined as Grade B or Grade C leak, .
90 days after surgery

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in the planned bowel transection margin after ICG assessment
Time Frame: One hour intraoperative
Change in the planned bowel transection margin after ICG assessment
One hour intraoperative
Operative time
Time Frame: Hours in the operative theater
Operative time taken from skin to skin
Hours in the operative theater
ICG-related adverse reactions, such as hypotension or allergic reaction
Time Frame: 4 Hours intraoperative
ICG-related adverse reactions, such as hypotension or allergic reaction
4 Hours intraoperative

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Alexandria University

Investigators

  • Principal Investigator: Ibrahim Magdy Ibrahim G. Ghallab, ALEXANDRIA UNIVERSITY FACULTY OF MEDICINE

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 2, 2025

Primary Completion (Actual)

September 4, 2026

Study Completion (Actual)

September 9, 2026

Study Registration Dates

First Submitted

September 13, 2026

First Submitted That Met QC Criteria

September 13, 2026

First Posted (Actual)

September 17, 2026

Study Record Updates

Last Update Posted (Actual)

September 17, 2026

Last Update Submitted That Met QC Criteria

September 13, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 0202285

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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