Intraoperative bowel perfusion assessment methods and their effects on anastomotic leak rates: Meta-Analysis

TY - JOUR

T1 - Intraoperative bowel perfusion assessment methods and their effects on anastomotic leak rates

T2 - Meta-Analysis

AU - Renna, Maxwell S.

AU - Grzeda, Mariusz T.

AU - Bailey, James

AU - Hainsworth, Alison

AU - Ourselin, Sebastien

AU - Ebner, Michael

AU - Vercauteren, Tom

AU - Schizas, Alexis

AU - Shapey, Jonathan

N1 - Funding Information: S.O. is co-founder and shareholder of Hypervision Surgical, and declares research funding from Medtronic and Siemens Healthineers. M.E., T.V., and J.S. are co-founders and shareholders of Hypervision Surgical. Funding Information: This work was supported by core funding from the Wellcome (WT203148/Z/16/Z), EPSRC Engineering and Physical Sciences Research Council (EPSRC, NS/A000049/1), and received funding from the National Institute for Health and Care Research (NIHR) (NIHR202114). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. T.V. is supported by a Medtronic and the Royal Academy of Engineering (RCSRF1819/7/34). Acknowledgements Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd.

PY - 2023/9/1

Y1 - 2023/9/1

N2 - Background: Anastomotic leak is one of the most feared complications of colorectal surgery, and probably linked to poor blood supply to the anastomotic site. Several technologies have been described for intraoperative assessment of bowel perfusion. This systematic review and meta-Analysis aimed to evaluate the most frequently used bowel perfusion assessment modalities in elective colorectal procedures, and to assess their associated risk of anastomotic leak. Technologies included indocyanine green fluorescence angiography, diffuse reflectance spectroscopy, laser speckle contrast imaging, and hyperspectral imaging. Methods: The review was preregistered with PROSPERO (CRD42021297299). A comprehensive literature search was performed using Embase, MEDLINE, Cochrane Library, Scopus, and Web of Science. The final search was undertaken on 29 July 2022. Data were extracted by two reviewers and the MINORS criteria were applied to assess the risk of bias. Results: Some 66 eligible studies involving 11 560 participants were included. Indocyanine green fluorescence angiography was most used with 10 789 participants, followed by diffuse reflectance spectroscopy with 321, hyperspectral imaging with 265, and laser speckle contrast imaging with 185. In the meta-Analysis, the total pooled effect of an intervention on anastomotic leak was 0.05 (95 per cent c.i. 0.04 to 0.07) in comparison with 0.10 (0.08 to 0.12) without. Use of indocyanine green fluorescence angiography, hyperspectral imaging, or laser speckle contrast imaging was associated with a significant reduction in anastomotic leak. Conclusion: Bowel perfusion assessment reduced the incidence of anastomotic leak, with intraoperative indocyanine green fluorescence angiography, hyperspectral imaging, and laser speckle contrast imaging all demonstrating comparable results.

AB - Background: Anastomotic leak is one of the most feared complications of colorectal surgery, and probably linked to poor blood supply to the anastomotic site. Several technologies have been described for intraoperative assessment of bowel perfusion. This systematic review and meta-Analysis aimed to evaluate the most frequently used bowel perfusion assessment modalities in elective colorectal procedures, and to assess their associated risk of anastomotic leak. Technologies included indocyanine green fluorescence angiography, diffuse reflectance spectroscopy, laser speckle contrast imaging, and hyperspectral imaging. Methods: The review was preregistered with PROSPERO (CRD42021297299). A comprehensive literature search was performed using Embase, MEDLINE, Cochrane Library, Scopus, and Web of Science. The final search was undertaken on 29 July 2022. Data were extracted by two reviewers and the MINORS criteria were applied to assess the risk of bias. Results: Some 66 eligible studies involving 11 560 participants were included. Indocyanine green fluorescence angiography was most used with 10 789 participants, followed by diffuse reflectance spectroscopy with 321, hyperspectral imaging with 265, and laser speckle contrast imaging with 185. In the meta-Analysis, the total pooled effect of an intervention on anastomotic leak was 0.05 (95 per cent c.i. 0.04 to 0.07) in comparison with 0.10 (0.08 to 0.12) without. Use of indocyanine green fluorescence angiography, hyperspectral imaging, or laser speckle contrast imaging was associated with a significant reduction in anastomotic leak. Conclusion: Bowel perfusion assessment reduced the incidence of anastomotic leak, with intraoperative indocyanine green fluorescence angiography, hyperspectral imaging, and laser speckle contrast imaging all demonstrating comparable results.

UR - http://www.scopus.com/inward/record.url?scp=85168744704&partnerID=8YFLogxK

U2 - 10.1093/bjs/znad154

DO - 10.1093/bjs/znad154

M3 - Review article

AN - SCOPUS:85168744704

SN - 0007-1323

VL - 110

SP - 1131

EP - 1142

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 9

ER -