Indocyanine green fluorescence angiography in mechanical bowel obstruction: impact on intraoperative decision-making and clinical guidance-a systematic review.

Authors

Fabio Ceccato, Peter Marinello, Stefan Patauner, Antonio Frena

Published in

Surgical endoscopy. Jul 13, 2026. Epub Jul 13, 2026.

Abstract

Mechanical bowel obstruction (MBO) is a common indication for emergency surgery. Intraoperative assessment of bowel viability remains challenging and relies largely on subjective visual criteria, while tactile evaluation is limited during laparoscopy. Indocyanine green fluorescence angiography (ICG-FA) has been proposed as an adjunct for real-time assessment of intestinal perfusion. This systematic review evaluated ICG-FA in MBO, focusing on intraoperative decision-making and postoperative outcomes.
A systematic search of PubMed, Embase, and the Cochrane Library was performed on February 27, 2026, in accordance with PRISMA 2020 guidelines. The protocol was registered in PROSPERO (CRD420261322769). The primary outcome was change in intraoperative surgical decision-making after ICG-FA. Secondary outcomes included bowel resection rate, postoperative complications, reoperation, and mortality. Qualitative synthesis and exploratory pooled descriptive analyses were performed.
Six studies including 125 patients met the inclusion criteria. ICG-FA was generally performed after obstruction resolution to assess bowel perfusion and inform surgical strategy. When explicitly assessed, changes in intraoperative strategy after ICG-FA were reported in 22-32% of cases, most frequently toward bowel preservation or less extensive resection. In pooled descriptive comparisons, bowel resection rates were numerically lower with ICG-FA than with conventional assessment alone (22.2% vs 41.9%). Postoperative complications showed a similar pattern (8% vs 32%). These findings should be interpreted as exploratory and descriptive.
ICG-FA may assist intraoperative assessment of bowel perfusion in MBO, particularly when bowel viability is uncertain. By organizing the available evidence in an emerging field, this review outlines a practical framework for ICG-FA use and may help guide standardized reporting and future prospective studies. Current evidence suggests a potential role in supporting intraoperative decision-making, often favoring bowel-preserving strategies. However, evidence remains limited and hypothesis-generating. Standardized protocols, decision modification reporting, prospective registries, and comparative studies are needed before the clinical impact of ICG-FA in MBO can be established.

PMID:
42443679
Bibliographic data and abstract were imported from PubMed on 14 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.