Leak after sleeve gastrectomy with positive intraoperative indocyanine green test: Avoidable scenario?

Giovanna Pavone, Nicola Tartaglia, Mario Pacilli, Francesca Maddalena, Fabio Petruzzelli, Antonio Ambrosi, Giovanna Pavone, Nicola Tartaglia, Mario Pacilli, Francesca Maddalena, Fabio Petruzzelli, Antonio Ambrosi

Abstract

Background: The staple line gastric leak (GL) is estimated to be the most serious complication of the sleeve gastrectomy. The use of indocyanine green (ICG) has been introduced in minimally invasive surgery to show the vascularization of the stomach in real time and its application to the gastroesophageal junction (GE) during Laparoscopic Sleeve Gastrectomy (LSG) seems very promising.

Case presentation: We present the case of a 40-year-old female underwent laparoscopic sleeve gastrectomy. Intraoperative indocyanine green test showed a small dark area in the proximal third of the staple line reinforced with fibrin glue. Two weeks later the patient presented to the emergency room (ED) with abdominal pain, fever, vomiting, intolerance to oral intake and the evidence of a leak on the abdomen Computer Tomography (CT). The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05337644 for the Organization UFoggia.

Conclusions: This case report shows that intraoperative ICG test can be helpful in determining which patients are at greater risk of the leak and, more importantly, the cause of the leak but further tests are needed to determine if the ICG predicts leak due to ischemia.

Keywords: Gastric fistula; Indocyanine green test; Laparoscopic sleeve gastrectomy.

Conflict of interest statement

GIOVANNA PAVONE, NICOLA TARTAGLIA, MARIO PACILLI, FRANCESCA MADDALENA, FABIO PETRUZZELLI, ANTONIO AMBROSI declare no conflict of interests.

Copyright © 2022. Published by Elsevier Ltd.

Figures

Fig. 1
Fig. 1
a. Evaluation of perfusion of staple line of the stomach by using Indocyanine green test. b: Intraoperative picture of the staple line of the stomach.
Fig. 2
Fig. 2
Gastrografin swallow test.
Fig. 3
Fig. 3
The collection and the air pocket adjacent to the staple line at the upper stomach on the abdominal CT.
Fig. 4
Fig. 4
The endoscopic evidence of the gastric fistula.
Fig. 5
Fig. 5
Self-expanding covered prosthesis placed to exclude the fistula.
Fig. 6
Fig. 6
Control abdomen CT that shows a clear reduction of the intra-abdominal collection.

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