A PROSPECTIVE STUDY ON ASSESSMENT OF BOWEL PERFUSION USING INDOCYANINE GREEN.pptx ASICON 2023.pptx

ICG

1. A prospective study on the surgical management of chronic pancreatitis DR VISMAYA K.B * DR VINAYA AMBORE, DR RIHAN RASHID

2. INTRODUCTION Chronic pancreatitis is a chronic inflammatory disease, characterised by irreversible, progressive destruction of pancreatic tissue, with progressive fibrosis of pancreas, leading to progressive loss of both exocrine and endocrine function Surgical Treatment offers long term pain relief which comes as a boon to the patients who are crippled physically, mentally as well as financially by long term intake of painkillers. Surgical treatment options include drainage procedures and resective procedures The surgical procedure can be carried out either via open approach or laparoscopically.

3. AIM 1. To compare outcomes of surgical management approaches (open Vs Laparoscopy) for treatment of chronic pancreatitis in terms of Mean operative time  Post-operative complications  Immediate post-operative pain  Length of post-operative stay           Blood loss Intraoperative complications  Post operative endocrine insufficiency

4. MATERIALS AND METHODS STUDY DESIGN: A prospective Cohort study carried out at tertiary care centre in an urban tertiary care hospital STUDY SITE: The study w as conducted in department of general surgery in an urban tertiary care hospital in Mumbai. SAMPLE SIZE: Minimum of 50 patients STUDY DURATION: 18 months (Followed up for 6 months later)

5. 1. Blood loss

6. DISCUSSION Table 1: Demographic comparison between previous studies and present study

7. INTRA -OPERATIVE FINDINGS: 1. PROCEDURE PERFORMED: Table 3 : Laparoscopic procedures performed in ICGand non-ICG groups.

8. Figure 01 : Laparoscopic ileal resection with ICG fluorescence Figure 2: Laparoscopic ileal resection without ICG fluorescence

9. 2. REVISION OF ANASTOMOTIC LINE AFTER ICG FLUORESCENCE: PROXIMAL REVISION - 12 PATIENTS AVERAGE DISTANCE - 2.83 CM DISTAL REVISION - 3 PATIENTS AVERAGE DISTANCE - 2 CM Chart 4 : Revision of proximal and distal anastomotic line after ICG fluorescence

10. 3. MEAN OPERATIVE TIME: The difference was statistically significant. ( p=0.014 ) Chart 5 : Comparison of the mean operative time in ICG and non-ICG groups. OBSERVATION AND RESULTS DISCUSSION Table 4: Comparison of mean operative time in previous studies and present study

11. 4 . BLOOD LOSS AND NEED FOR BLOOD TRANSFUSION The difference was statistically insignificant. (p=0.117) Chart 6 : Mean blood loss and need for intra operative BT in ICG and non-ICG groups OBSERVATION AND RESULTS DISCUSSION Table 5 : Comparison of mean blood loss in previous studies and present study

12. POST OPERATIVE FINDINGS: 1.ICU STAY: The difference was statistically insignificant. (p=0.276) Chart 7 : Comparison between mean ICU stay in ICG and non-ICG group

13. 2. PARALYTIC ILEUS: OBSERVATION AND RESULTS DISCUSSION Table 6 : Comparison of paralytic ileus in previous studies and present study Chart 8 : Comparison of post-operative paralytic ileus between ICG and non-ICG group

14. 3 . INCIDENCE OF ANASTOMOTIC LEAK: The difference was found to be statistically significant. (p=0.00005) OBSERVATION AND RESULTS DISCUSSION Table 7 : Comparison of AL between previous studies and present study Chart 9 : Comparison of incidence of anastomotic leak in ICG and non-ICG group

15. OBSERVATION AND RESULTS DISCUSSION 4. NEED FOR RE-EXPLORATION: (The difference was statistically insignificant. (p=0.46) ) Chart 1 : Incidence of anastomotic leak with post operative management of the same Table 8 : Comparison of re-exploration rate in previous studies and present study

16. OBSERVATION AND RESULTS DISCUSSION 5 . HOSPITAL STAY UNDER SURGERY DEPARTMENT : (The difference was statistically insignificant. (p=0.058) ) Table 09 Comparison of mean hospital stay in previous studies and present study Chart 1 1 : Comparison of mean hospital stay in ICG and non-ICG group

17. LIMITATIONS L arge sample size from a representative population in a multi centric setting can substantiate the evidence. Quantification will add more value

18. SUMMARY Demography- Equally represented B iochemical parameters - No difference between the groups. Most common indication for the surgery was colorectal malignancy followed IBD. The most commonly performed procedure in the present study was right hemicolectomy with ileo-colic anastomosis followed by left hemicolectomy with colo-colic anastomosis and anterior resection.

19. Revision of proximal and distal anastomosis line in the ICG group after ICG fluorescence assessment of the bowel perfusion was performed in 12 and 3 patients respectively with mean length of 2.83 and 2 cm, respectively. The mean operative time was significantly higher in the ICG group as compared to the non_ICG one (246.25min and 198.94min respectively). Incidence of anastomotic leak was nil and 18.75% in the respective group and the association was to be statistically significant. Out of 3 patients who got anastomotic leak in the latter group, 2 were re-explored and one was successfully treated on conservative management. No mortality or loss to followup

20. CONCLUSION We conclude that the use of ICG dye is a valuable tool to supplement the Intraoperative assessment of bowel perfusion by the surgeon which is essential for effective healing of anastomotic line . It also allows confirmation and documentation of adequate perfusion of anastomotic line and therefore it is associated with lower post-operative anastomotic leaks with the cost of higher operative time. However, the latter can be brought down by improving personal operative skills and use of newer and more straightforward software systems for objective analysis of ICG enhancement.

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