The Value of Intraoperative Indocyanine Green Angiography to Assess Anastomotic Perfusion and Leakage in Patients Undergoing Laparoscopic Colorectal Resection: a Randomized Controlled Clinical Trial

Background and Aim: Anastomotic leaking (AL) is a significant obstacle in colorectal surgery, with potential life-threatening consequences. Insufficient perfusion during surgery is one factor that can contribute to AL. Intraoperative angiography with indocyanine green (ICG) is a noninvasive imaging procedure that can monitor perfusion. This randomized controlled trial will investigate whether ICG angiography can decrease the frequency of AL and improve patient outcomes following laparoscopic colorectal resection. Methods: The clinical trial involved adult cases with a tumor located between 2 and 15 cm from the anal verge, who had colorectal anastomosis performed during colectomy or laparoscopic anterior rectal resection. The study group received ICG intravenously to aid in the assessment of bowel perfusion, while the control group received subjective evaluation. The adequacy of bowel perfusion was assessed during surgery to judge the level of colonic resection. Results: There was no significant distinction in demographics among the study and placebo groups. Wound infection and rectal bleeding were higher in the control group. Age, malignant disease, and diabetes were correlated with Clavien-Dindo severity, while neoadjuvant therapy was linked to higher scores. BMI and CAD had no association with Clavien-Dindo. The intervention reduced AL occurrence. Conclusion: Insufficient perfusion at the resection margins during colorectal resection can be successfully demonstrated with intraoperative fluorescence angiography with ICG, which is safe and not time-consuming.