Utilization of indocyanine green fluorescence angiography in redo IPAA surgery

Redo/revisional ileal pouch-anal anastomosis (IPAA) surgery is technically challenging and more likely to require mesenteric lengthening maneuvers, largely due to mesenteric reach issues, which may affect the perfusion of the critical sites in the pouch. Indocyanine green fluorescence angiography (ICG-FA) offers real-time assessment of tissue perfusion and may reduce the risk of complications, such as anastomotic leak. We aimed to evaluate the impact of intraoperative ICG-FA on surgical outcomes in patients undergoing redo/revisional IPAA surgery. This is a retrospective case-control study with 1:1 propensity score matching based on data from a high-volume quaternary inflammatory bowel disease center. Patients who underwent redo/revisional IPAA surgery between September 2016 and December 2023 were included. The primary objective was to evaluate the direct impact of ICG-FA on intraoperative decision-making, measured by the rate of change in surgical plan. Secondary objectives included an exploratory comparison of short- and long-term outcomes, such as anastomotic leak and major complications. A total of 46 patients were included, with 23 patients in each of the ICG and non-ICG groups. ICG-FA led to intraoperative changes in surgical management in 2 patients (8.7%), including one pouch augmentation with resection of the tip of the J pouch and one pouch excision. The 30-day major complication rate was lower in the ICG group (11.1%) compared to non-ICG (18.2%), though not statistically significant ( p = 1.00). No significant difference was found in long-term complication rates after adjusting for a marked disparity in follow-up duration between the groups. No adverse reactions related to ICG-FA were observed. ICG-FA is a safe and feasible adjunct during redo/revisional IPAA surgery. Its use may guide intraoperative decision-making, leading to timely revisions.