Background

Bile Reflux is an area of controversy in OAGB. ICG is preferentially metabolized in the liver and excreted in the bile. ICG can be utilized to identify the exact location of the pylorus, the presence of bile refluxing into the stomach and the flow of bile past the gastrojejunostomy in OAGB

Methods

10 patients undergoing OAGB received 7.5 mg of ICG one hour prior to induction of anesthesia. All cases were assessed for intra duodenal presence of ICG, Intragastric presence of ICG and jejunal presence of ICG. ICG in the duodenum was assessed to assist in locating the pylorus.

Results

In all cases ICG was visible in the proximal duodenum and allowed easy visualization of the pylorus as a distinct and separate structure from the antrum. In 2 cases ICG was visible in the lumen of the stomach and the presence of intragastric bile was confirmed on OG aspiration of bile. In all ten cases ICG was heavily concentrated in the proximal jejunum and was visible in both the biliopancreatic limb and the common channel but not in the gastric pouch after creation of the gastrojejunostomy

Conclusions

Preoperative administration of ICG can assist in determining the anatomic location of the pylorus. The intra luminal concentration of bile in the jejunum can assist in demonstrating preferential flow of bile into the common channel and away from the gastric pouch during one anastomosis gastric bypass.