Assessment of intra-operative bowel perfusion in children using indocyanine green: an exploratory study investigating its effect on surgical management

BACKGROUND: Intra-operative bowel perfusion assessment using indocyanine green (ICG) is an emerging technology that may improve outcomes in paediatric surgery. We aimed to investigate whether intra-operative perfusion assessment using ICG would change a surgeon's management plan in children undergoing elective stoma closure. METHODS: Four operative videos (two ileostomy and two colostomy closures) showing proximal and distal limbs of bowel immediately prior to anastomosis were independently assessed by paediatric surgeons. Prior to the intravenous injection of ICG, surgeons were asked if perfusion in each stoma limb was 'adequate' or 'poor', and whether they would complete an anastomosis. After injection of ICG, the same questions were repeated. Primary outcome was the proportion of surgeons who changed their plan after witnessing ICG administration. RESULTS: In all four stoma closures there were no operative complications and no adverse events related to ICG injection. Twenty-four surgeons participated in the study, resulting in 96 assessments. Twelve (50%) surgeons changed their management plan at least once after witnessing ICG administration. Nineteen surgeons (79%) considered ICG to be useful in this context. Surgeons stated ICG perfusion assessment was useful to confirm their visual assessment of bowel perfusion. Participants highlighted the lack of data linking intra-operative bowel perfusion assessment with ICG to surgical outcomes in children. CONCLUSIONS: Assessment of intra-operative bowel perfusion using ICG resulted in 50% of surgeons changing their management plan. The majority of surgeons believed that ICG was useful in this context. However, the relationship between ICG perfusion and clinical outcomes remains unknown.