Strategy to Avoid Anastomotic Leakage in Laparoscopic Colorectal Resection Using the Indocyanine Green Fluorescence System

Purpose: Anastomotic leakage (AL) in colorectal resections is often caused by insufficient blood flow to the stump. Injecting indocyanine green can help detect blood flow intraoperatively. In this study, we evaluated our original strategy using an indocyanine green fluorescence system to avoid AL. Methods: We retrospectively evaluated 79 patients who underwent laparoscopic colorectal resection for colon cancer using a double-stapling technique. Blood flow in oral stumps was evaluated by measuring indocyanine green fluorescence time (FT). We investigated AL cases in detail and analyzed correlations between FT and risk factors for AL. Results: Of the 79 patients, 7 (8.9%) developed AL. We divided patients by FTs: >60 seconds, 50 to 60 seconds, and <50 seconds. The AL rates were FT >60 seconds, 60%; FT 50 to 60 seconds, 10.3%; and FT <50 seconds, 2.2%. The AL rate of high-risk cases (with more than 2 risk factors) were calculated and we made our original strategy to avoid AL as the following. Further resection or diverting stomas were needed by the FT >60 seconds group, and by members of the FT 50 to 60 seconds group with >= 3 risk factors. The FT <60 seconds group needed no additional management. Conclusions: Patients with delayed FT (>60 seconds, or 50-60 seconds with >= 3 risk factors) may need revision of the anastomosis (diverting stoma or additional resection) to avoid AL. Our original strategy may contribute to reduce AL in colorectal operations.