Feasibility of quantitative analysis of colonic perfusion using indocyanine green to prevent anastomotic leak in colorectal surgery.

BACKGROUND: The aim of this study was to quantify Fluorescence angiography with indocyanine green (ICG) in colorectal cancer anastomosis, determine influential factors in its temporary intensity and pattern, assessing the ability to predict the AL, and setting the cut-off levels to establish high- or low-risk groups. METHODS: Retrospective analysis of prospectively managed database, including 70 patients who underwent elective surgery for colorectal cancer in which performing a primary anastomosis was in primary plan. In all of them, ICG fluorescence angiography was performed as usual clinical practice with VisionSense™ VS Iridium (Medtronic, Mansfield, MA, USA), in Elevision™ IR Platform (Medtronic, Mansfield, MA, USA). Parameters measured at real time or calculated were T0, Tmax, ∆T, Fmax, %pos, Fpos, and Slope. RESULTS: 70 patients were included, 69 anastomosis were performed and one end colostomy. Arterial hypertension demonstrated higher Fmax, as well as the location of the anastomosis (the nearest to rectum, the most intensity detected). A statistical relationship was found between AL and the lower Fpos and Slope. The decision of changing the subjectively decided point of division did not demonstrate statistical difference on the further development of AL. All parameters were analyzed to detect the cut-off related with AL. Only in case of Fpos lower than 158.3 U and Slope lower than 13.1 U/s p-value were significant. The most valuable diagnostic parameter after risk stratification was the Negative Predictive Value. CONCLUSION: Quantitative analysis of ICG fluorescence in colorectal surgery is safe and feasible to stratify risk of AL. Hypertension and location of anastomosis influence the intensity of fluorescence at the point of section. A change of division place should be considered to avoid AL related to vascular reasons when intensities of fluorescence at the point of section is lower than 169 U or slopes lower than 14.4 U/s.

Resultados a un año tras desarterialización hemorroidal guiada por doppler / One year follow-up after doppler-guided haemorrhoidal artery ligation

Introducción: La desarterialización hemorroidal guiada por doppler (THD) es una técnica no exerética para el tratamiento de las hemorroides, consistente en la ligadura de las ramas distales de la arteria rectal superior. El propósito de este trabajo es evaluar la seguridad y eficacia de esta técnica tras un seguimiento de un año. Material y método Se intervienen 30 pacientes mediante THD por hemorroides sintomáticas grado II o III. La media de edad fue de 49,9 años (30-70 años). En todos se utilizó el dispositivo THD®. Los procedimientos se realizaron bajo anestesia intradural en régimen de corta estancia. Evaluamos tiempo operatorio, dolor, sangrado, estancia postoperatoria, complicaciones y síntomas tras 3-6 y 12 meses. Resultados El tiempo operatorio medio fue de 23 minutos (15-50). El valor de dolor según la escala visual analógica (EVA) fue durante el primer día de 5,5 (el 90% requirió analgesia). Tras el segundo día, sólo 2 pacientes necesitaron analgesia. Un paciente describió dolor persistente hasta los 3 meses, 2 sangrado leve. Una reintervención por trombosis hemorroidal al 10° día. No otras complicaciones. No reingresos. Estancia media: 1,4 días (0-2), y el restablecimiento de actividad diaria normal se realizó a los 7-8 días. 26 pacientes (87%) describen tenesmo, autolimitado en 3 meses. Tras un año, 2 pacientes han sido reintervenidos, 3 han recurrido (2 prolapsos leves y 1 sangrado ocasional). La tasa de resolución total fue del 80%.ConclusionesLa desarterialización hemorroidal guiada por doppler parece ser efectiva tras un año, con un porcentaje de complicaciones bajo (AU)

Introduction: The Doppler-guided haemorrhoidal artery ligation (DG-HAL) is a non-exeresis technique for the treatment of haemorrhoids, consisting in the ligature of the distal branches of the upper rectal artery. The aim of this work is to evaluate the safety and efficacy of this technique after one year of follow-up. Material and method: A total of 30 patients were operated on using DG-HAL for grade II or IIIhaemorrhoids. The mean age was 49.9 years (30-70 years). The THD1 (Transanal Haemorrhoidal Dearterialisation) device was employed in all cases. The procedures were performed under intradural anaesthesia in a short-stay surgery unit. The operating time, pain, bleeding, postoperative stay, and complications and symptoms after 3-6 months and 12 months were recorded. Results: The mean operating time was 23 minutes (15-50). The pain according to a visual analogue scale (VAS) was 5.5 during the first day (90% required analgesia). Only 2 patients required analgesia after the second day. One patient described persistent pain up to3 months, and 2 slight bleeding. A further operation was performed due to a haemorrhoidal thrombosis on the 10thday. There were no other complications and no re-admissions. The mean hospital stay was 1.4 days (0-2), and normal daily activity re-established at 7-8 days. Alarge majority (87%) of patients described having tenesmus, which disappeared in 3months.After one year, two patients had had further operations, 3 had recurrences (2 slightprolapses and 1 occasional bleeding). The success rate was 80%.Conclusions: Haemorrhoidal de arterialisation using Doppler-guided arterial ligation seems to be effective after one year, with a low percentage of complications (AU)

[One year follow-up after doppler-guided haemorrhoidal artery ligation]. / Resultados a un año tras desarterialización hemorroidal guiada por doppler.

INTRODUCTION: The Doppler-guided haemorrhoidal artery ligation (DG-HAL) is a non-exeresis technique for the treatment of haemorrhoids, consisting in the ligature of the distal branches of the upper rectal artery. The aim of this work is to evaluate the safety and efficacy of this technique after one year of follow-up. MATERIAL AND METHOD: A total of 30 patients were operated on using DG-HAL for grade II or III haemorrhoids. The mean age was 49.9 years (30-70 years). The THD® (Transanal Haemorrhoidal Dearterialisation) device was employed in all cases. The procedures were performed under intradural anaesthesia in a short-stay surgery unit. The operating time, pain, bleeding, postoperative stay, and complications and symptoms after 3-6 months and 12 months were recorded. RESULTS: The mean operating time was 23minutes (15-50). The pain according to a visual analogue scale (VAS) was 5.5 during the first day (90% required analgesia). Only 2 patients required analgesia after the second day. One patient described persistent pain up to 3 months, and 2 slight bleeding. A further operation was performed due to a haemorrhoidal thrombosis on the 10(th) day. There were no other complications and no re-admissions. The mean hospital stay was 1.4 days (0-2), and normal daily activity re-established at 7-8 days. A large majority (87%) of patients described having tenesmus, which disappeared in 3 months. After one year, two patients had had further operations, 3 had recurrences (2 slight prolapses and 1 occasional bleeding). The success rate was 80%. CONCLUSIONS: Haemorrhoidal dearterialisation using Doppler-guided arterial ligation seems to be effective after one year, with a low percentage of complications.