Indocyanine Green Angiography in Pediatric Colorectal Surgery
Abstract
Hirschsprung Disease (HD) and Anorectal Malformations (ARM) are congenital colorectal conditions that necessitate surgical correction via bowel resection with the creation of an anastomosis. Surgical complications, thought to be in part due to malperfusion of the bowel anastomosis, are frequent, as revealed by the retrospective review enclosed. Indocyanine Green Angiography (ICGA) is a process in which water-soluble dye (ICG) is used to assess perfusion of tissue, and it has been employed with success in adult populations to reduce rates of anastomotic leak during colorectal surgery. The systematic review conducted within confirms that this tool has not been extensively studied in pediatric patients undergoing bowel resection. To understand the feasibility of conducting an adequately powered multi-centered trial to determine if ICGA reduces the rates of malperfusion-related complications such as anastomotic stricture, leak, or dehiscence during pull-through for HD or ARM, a feasibility randomized controlled trial was conducted. We found that the designed protocol achieved a recruitment rate of 80%, which met our prespecified criteria to proceed with a larger study. Further research into the utility of ICGA in pediatric colorectal surgery is required.