Is ICG-enhanced image able to help predicting pancreatic fistula in laparoscopic pancreaticoduodenectomy?

Abstract

Laparoscopic pancreaticoduodenectomy (PD) has been reported to be technically feasible and safe. Successful pancreatico-enteric anastomosis in particular is important for safe PD. Intraoperative perfusion of the remnant pancreas can be evaluated with ICG technology and be applied in pancreatic reconstruction in PD. A 68-year old female patient with distal common bile duct cancer underwent laparoscopic pylorus-preserving pancreaticoduodenectomy. After pancreaticojejunostomy (PJ), we checked perfusion of the anastomosis line using an ICG imaging system and noticed a perfusion defect at the anterior wall. The patient developed a grade A postoperative pancreatic fistula, but was discharged without major sequelae. Even though pancreatic perfusion after laparoscopic PJ appeared adequate based on white light, hypo-perfusion was noted under infrared light. Our experience suggests that ICG technology may be more sensitive than white light for detecting pancreatic perfusion in pancreatic anastomoses. However, the clinical implications of this require further investigation.

Key words:

• Indocyanine green
• laparoscopic pancreaticoduodenectomy
• anastomosis site perfusion
• postoperative pancreatic fistula
• pancreaticojejunostomy

Acknowledgements

This research was supported by a grant from National Research Foundation (NRF-2016K1A3A1A12953723).

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This work was supported by National Research Foundation of Korea [NRF-2016K1A3A1A12953723].