Anastomosis Viability Assessment in Colorectal Surgery

  • Mahmoud Abu Gazala
  • Steven D. WexnerEmail author


Anastomotic leak remains one of the most dreaded complications in colorectal surgery and is responsible for significant morbidity and mortality. While the risk for anastomotic leak is multifactorial and may not be totally eliminated, there has been much evidence that intraoperative fluorescence angiography is a safe and easy technique by which the incidence of anastomotic leaks can be reduced. We will review the risk factors for anastomotic leak, the technique of fluorescence angiography, and significant publications on this topic.


Anastomotic leak Fluorescence imaging Fluorescence angiography Colon resection Proctectomy Colorectal anastomosis 

Supplementary material

Video 19.1

Evaluation of the bowel perfusion during sigmoid colectomy just prior to bowel transection. After we have decided on the location of the proximal site of division, an intravenous bolus of 3.5 mL of ICG is administered, and using a near-infrared (NIR) camera, the quality and distribution of florescence angiogram is evaluated. As can be seen in this video, there is a clear demarcation line between perfused and non-perfused bowel, allowing for a confident transection of bowel. (MP4 25665 kb)

Video 19.2

Following creation of a colorectal anastomosis during this laparoscopic sigmoid colectomy, another bolus of ICG is administered in order to evaluate the serosal surface of the anastomosis. The video clearly demonstrates perfect anastomotic perfusion. (MP4 15867 kb)

Video 19.3

Following colorectal anastomosis, a scope with NIR camera is inserted to the bowel lumen through the anus, and a third bolus of ICG is administered. This video demonstrates perfect anastomotic perfusion at the mucosal side of the anastomosis. (MP4 24814 kb)


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Colorectal DepartmentCleveland Clinic FloridaWestonUSA
  2. 2.Department of Colorectal SurgeryDigestive Disease Center, Cleveland Clinic FloridaWestonUSA

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