Application of indocyanine green in gastric band-to-one gastric bypass (gbab) conversion surgery: a safe option against ischemic leaks? a case report
DOI:
https://doi.org/10.24054/cbs.v4i3.4532Keywords:
Bariatric surgery, Indocyanine green, Fluorescence, Gastric bypass, Morbid obesityAbstract
Introduction: Obesity has become one of the chronic diseases with the greatest impact on public health, due to its high prevalence and its close association with multiple metabolic and cardiovascular comorbidities. Thus, metabolic surgery has emerged as an effective alternative for the management of these diseases. However, the various established techniques have a certain percentage of complications, with anastomotic leaks being one of the most feared complications in revisional surgery, frequently linked to tissue hypoperfusion. The use of indocyanine green allows for the dynamic and real-time assessment of tissue microvascularization, providing an objective intraoperative criterion for its viability. This study aims to describe the usefulness of intraoperative fluorescence using indocyanine green as a tool for the objective evaluation of tissue perfusion during gastric banding to single-anastomosis gastric bypass (SAGB) conversion, to optimize surgical safety and reduce the risk of anastomotic leaks. Clinical Description and Therapeutic Management: We present the case of a 43-year-old female patient with morbid obesity and multiple metabolic comorbidities, who had a gastric band implanted eight years prior. Laparoscopic revision surgery was performed with explantation of the device, creation of a gastric pouch, and a single gastrojejunal anastomosis. Subsequently, intravenous indocyanine green was administered for angiographic assessment of tissue perfusion, demonstrating adequate vascularization of the gastric pouch and the jejunal loop. Conclusions: The intraoperative application of indocyanine green confirmed the vascular viability of the anastomosed tissues, contributing to a favorable postoperative course without complications. This technology represents a promising tool for increasing safety in revisional bariatric surgery and optimizing intraoperative surgical decision-making.
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