Intraoperative quantitative analysis of intestinal perfusion by ICG fluorescence in Hirschsprung disease: a single-center retrospective cohort study.

Abstract

Objective: Postoperative complications at the coloanal anastomosis site following surgery for Hirschsprung disease (HSCR) can significantly impact bowel function recovery in children. Indocyanine green (ICG) fluorescence imaging provides a real-time, quantitative assessment of perfusion, potentially improving surgical outcomes. This study aims to evaluate the effectiveness of an ICG-based quantitative perfusion analysis strategy compared to conventional visual assessment in determining anastomotic site selection.

Methods: This single-center retrospective study included consecutive patients with histologically confirmed HSCR who underwent surgery between January 2023 and January 2024. Following vascular arcade ligation and transanal pull-through, anastomotic site selection was guided either by conventional visual assessment (Visual Group) or ICG fluorescence angiography with quantitative perfusion analysis (ICG Group). We chose the specific ICG perfusion parameters (Fmax > 30 AU, Tmax < 30 s) as safe anastomotic site thresholds. Postoperative complications, functional outcome and perianal ultrasound findings were assessed during follow-up.

Results: A total of 167 patients were included, with 34 in the ICG Group and 133 in the Visual Group. Both groups had comparable baseline characteristics. While no significant differences were observed in postoperative bowel movement recovery or major anastomotic complications, perianal ultrasound at 5-7 days postoperatively revealed significantly reduced anastomotic inflammation in the ICG Group. Follow-up analysis showed that the ICG Group had a shorter hospital stay (7 days, IQR 7-8 vs. 8 days, IQR 7-10.5, p = 0.003), as well as a higher percentage of HAEC-free patients (78.1% for ICG vs. 56.8% for Visual) compared to the Visual Group.

Conclusion: Quantitative ICG fluorescence imaging provides a more precise and objective approach for anastomotic site selection in HSCR surgery. This strategy may reduce postoperative anastomotic inflammation and HAEC. Further studies are needed to validate its long-term clinical benefits and establish standardized protocols for pediatric colorectal surgery.