Background

As the technique for performing the SADI-s operation has evolved, division of the right gastric artery has been advocated as a necessary means of mobilizing the proximal duodenum. Division of the right gastric artery has been associated with ischemia of the duodenum leading to the intraoperative discovery of a 'blue duodenum'. Division of the right gastric artery can be avoided with utilization of ICG angiography to allow selective dissection of the duodenum and preservation of the major vascular supply to this area.

Methods

10 patients undergoing SADI-s procedures received 7.5 mg of ICG to allow visualization of the gastroduodenal artery and the blood supply coming off the right gastric artery supplying the proximal duodenum. Dissection of the duodenum was completed using ICG arteriography to minimize disruption of the blood supply to the duodenum.

Results

Preservation of the right gastric artery was accomplished in all cases. Selective dissection of the duodenum using ICG arteriography allowed for adequate mobilization of the duodenum. Hand sewn duodenal ileostomy was completed in all cases. A 'Blue duodenum' was avoided in all cases and excellent perfusion of the duodenum was confirmed in all cases using a final perfusion bolus of 7.5 mg of ICG. There were no anastomotic leaks

Conclusions

ICG arteriography of the gastroduodenal artery allows direct visualization of the blood supply to the proximal duodenum can assist in preserving the right gastric artery. Preservation of the right gastric artery utilizing ICG arteriography was associated with better perfusion of the duodenum.