Using fluorescein angiography to assess the blood supply of the fundoplication wrap in one-anastomosis gastric bypass in the “Fundoring” modification

In laparoscopic surgery, fluorescein angiography using indocyanine green (ICG) is actively used to assess the blood supply to tissues and organs in real time. The aim of this study was to assess the blood supply and perfusion of the small formed gastric pouch, fundoplication wrap (FW), gastroenteroanastomosis and the excluded part of the stomach in one-anastomosis gastric bypass in the “FundoRing” modification in comparison with the standard technique.Methods. The study is a prospective, open-label, randomized, controlled trial conducted from April 2021 to October 2024, in which 200 patients participated. The patients were divided into two groups: 100 patients in the “FundoRingOAGB” group, who underwent laparoscopic one-anastomosis gastric bypass in the “FundoRing” modification, and 100 patients in the “OAGB” group using the standard technique. ICG was used at a dose of 12.5 mg, and visualization was performed using the KARL STORZ – IMAGE1 S™ Rubina® system.Results. 200 patients successfully underwent laparoscopic one-anastomosis gastric bypass, without complications. The average time of fluorescence appearance of the small formed gastric pouch, gastroenteroanastomosis and disconnected part of the stomach was 16.76 ± 6.71 seconds for the “OAGB” group and 15.8 ± 5.95 seconds for the “FundoRingOAGB” group, P-value = 0.28. The left part of the FW showed luminescence simultaneously with other areas, while the right part, passing through the retroesophageal orifice, began to glow later, on average 32.7±14.23 seconds. No cases of FW necrosis in the postoperative period were recorded.Conclusion. Using fluorescein angiography, it was confirmed that with one-anastomosis gastric bypass in the “FundoRing” modification, adequate blood supply to the small formed gastric pouch, gastroenteroanastomosis, excluded part of the stomach and FW is maintained. The gastric bypass technique in the “FundoRing” modification can be safely used in bariatric and metabolic surgery.Key words. Bariatric surgery; fluorescein angiography; one-anastomosis gastric bypass; indocyanine green; fundoplication; FundoRing; obesity; metabolic syndrome.