Indocyanine green angiography of gastric stump in primary and secondary bariatric surgeries

The failure of the stapler suture line and gastroenteroanastomosis following bariatric surgeries can result in life-threatening complications. One of the most promising and thoroughly described methods of intraoperative assessment of the quality of blood supply and perfusion of the gastric stump is indocyanine green (ICG) angiography. A decrease in perfusion in the area of the Gis angle is observed in almost no patients who have undergone revision surgeries. This appears to be associated with a long period of adaptation following the primary surgery and the development of collaterals. In light of the aforementioned considerations, it is recommended that patients with a comorbid background (e.g., steatohepatosis, type 2 diabetes mellitus, atherosclerosis) undergo RYGB rather than OAGB. This approach will ensure more intensive perfusion of the stomach stump and the area of gastroenteroanastomosis, thereby reducing the risk of ischemic complications.