Eur J Pediatr Surg 2020; 30(06): 505-511
DOI: 10.1055/s-0039-1700548
Original Article

Preliminary Use of Indocyanine Green Fluorescence Angiography and Value in Predicting the Vascular Supply of Tissues Needed to Perform Cloacal, Anorectal Malformation, and Hirschsprung Reconstructions

1  Center for Pelvic and Colorectal Reconstruction, Nationwide Children’s Hospital, Columbus, Ohio, United States
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Devin R. Halleran
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Hira Ahmad
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
3  Department of Pediatric Surgery, University Hospital La Paz, Madrid, Spain
,
Alessandra C. Gasior
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Katherine McCracken
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Geri D. Hewitt
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Victoria Alexander
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Caitlin Smith
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Laura Weaver
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Richard J. Wood
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
,
Marc A. Levitt
2  Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
› Author Affiliations

Abstract

Introduction Reconstructive techniques for cloaca, anorectal malformations (ARM), and Hirschsprung disease (HD) may require intestinal flaps on vascular pedicles for vaginal reconstruction and/or colonic pull-throughs. Visual assessment of tissue perfusion is typically the only modality used. We investigated the utility of intraoperative indocyanine green fluorescence angiography (ICG-FA) and hypothesized that it would be more accurate than the surgeon's eye.

Materials and Methods Thirteen consecutive patients undergoing cloacal reconstruction (9), HD (3), and ARM repair (1) underwent ICG-FA laser SPY imaging to assess colonic, rectal, vaginal, and neovaginal tissue perfusion following intraoperative visual clinical assessment. Operative findings were correlated with healing at 6 weeks, 3 months, and 1 year postoperatively.

Results ICG-FA resulted in a change in the operative plan in 4 of the 13 (31%) cases. In three cases, ICG-FA resulted in the distal bowel being transected at a level (>10 cm) higher than originally planned, and in one case the distal bowel was discarded, and the colostomy used for pull-through.

Conclusion ICG-FA correctly identified patients who might have developed a complication from poor tissue perfusion. Employing this technology to assess rectal or neovaginal pull-throughs in cloacal reconstructions, complex HD, and ARM cases may be a valuable technology.



Publication History

Received: 20 June 2019

Accepted: 17 September 2019

Publication Date:
13 December 2019 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany