The usefulness of fluorescence in decision-making strategy during bariatric and metabolic surgery

Fluorescence is used in various surgical fields to detect tissue ischemia. However, its use in obesity surgery is still limited. This study aims to investigate whether fluorescence can change surgical decisions during metabolic and bariatric surgery. The primary objective was to determine the proportion of patients with abnormal blood flow assessed by fluorescence and changes in intraoperative strategy. The second outcome measured was the morbidity and mortality within 30 days.

This single-centre, prospective observational study analysed patients who underwent primary metabolic and bariatric surgery. Data was collected from 66 consecutive patients who qualified for primary one anastomosis gastric bypass and Roux-en-Y gastric bypass procedures.

In total, improper blood supply was observed in two cases, and surgical strategy was changed in 5.8% of OAGB and 2% of RYGB. No leakage incidents were reported. One patient (1.5%) experienced non-ischemic-related complications. No mortality was observed 30 days after the surgical procedures. No complications related to ICG administration were observed.

Despite the low incidence of tissue ischemia during metabolic and bariatric surgery, adding ICG fluorescence may potentially impact intraoperative surgical decisions due to ischemia detection during metabolic and bariatric surgery. However, this field lacks systematic data, and further research with a larger patient group is necessary to establish conclusive evidence.