IMPLEMENTATION OF INDOCYANINE GREEN IN CONVERSION FROM GASTRIC BAND TO OAGB: A SAFE OPTION AGAINST ISCHEMIA LEAKS?

Presenting By: 15th World Endoscopy and GI Conference
Dates: December 17-19, 2025
Venue: Dubai, UAE

Name:  Pablo Segales Bautista
Research interest: New minimally invasive and safe techniques for anastomotic vasculature in digestive surgery

Introduction:
Conversion from gastric banding to single-anastomotic gastric bypass (SGB) is an effective alternative to long-term gastric band failure, although it entails increased technical risks, particularly related to fibrosis, periband adhesions, and anatomical distortion. One of the most feared risks in this context is anastomotic leak, frequently linked to tissue ischemia secondary to inadequate perfusion. Intraoperative indocyanine green (ICG) fluorescence, captured by near-infrared imaging, has emerged as an effective tool for real-time assessment of tissue viability during complex bariatric procedures.

We describe the case of a 51-year-old female patient with type III obesity, a history of multiple abdominal surgeries, and a failed gastric band implant in 2011. She underwent successful conversion to SGB using a laparoscopic approach. During the procedure, ICG was administered at a dose of 0.1 mg/kg. Two minutes later, perfusion assessment showed adequate vascularization of the gastric pouch and gastrojejunal anastomosis, even in high-risk areas such as the angular notch. The procedure was complemented by a negative pneumatic test and intraoperative endoscopy, and was completed without postoperative complications.

This finding aligns with recent studies reporting the clinical utility of ICG in bariatric surgery. Wityket al. (2024) identified hypoperfusion in 3% of patients undergoing OAGB, modifying the intraoperative strategy to prevent leaks [1]. Carandinate al. (2023) reported a change in surgical approach in 3.8% of cases, with a low incidence of complications (0.71%) [2]. Likewise, Schools et al. (2023) highlighted its value in revisional surgery with complex anatomies [3].

In conclusion, the use of indocyanine green in revisional bariatric surgery, specifically in the conversion of band to OAGB, allows for an objective and dynamic assessment of tissue perfusion, constituting an adjuvant tool that enhances surgical safety and may reduce the risk of ischemia-associated complications. Additional controlled trials are required to validate its definitive impact on long-term clinical outcomes.

Keywords:  Indocyanine green, anastomotic leak, gastric band, single anastomotic gastric bypass (OAGB), revision surgery.

References:

1. Wityk R, Daskalakis M, Zacharoulis D, et al. Intraoperative indocyanine green fluorescence angiography during one anastomosis gastric bypass: A prospective evaluation of perfusion and surgical decision-making. Surg Endosc. 2024;38(5):3451–3459. doi:10.1007/s00464-024-10412-x.
2. Carandina S, Dallemagne B, Perretta S, et al. Impact of indocyanine green fluorescence imaging on surgical strategy in bariatric procedures: A systematic review and meta-analysis. Obes Surg. 2023;33(10):2905–2915. doi:10.1007/s11695-023-06798-4.
3. Schols RM, Bouvy ND, van Dam RM. Near-infrared fluorescence imaging with indocyanine green for perfusion assessment in revisional bariatric surgery: A promising tool for complex cases. Sci Rep. 2023;13(1):7812. doi:10.1038/s41598-023-35052-6.

Biography:

Dr. Pablo Segales Bautista, obtained his degree in medical surgery from the Universidad Mayor de San Andrés (Bolivia), specialized in general and gastroenterological surgery at the Bolivian-Japanese Gastroenterological Institute of the Universidad Mayor Real y Pontifician San Francisco Xavier (Bolivia), completed a high specialty in advanced laparoscopic surgery at the CES University of Medellín (Colombia), and a subspecialty in bariatric and metabolic surgery at the Autonomous University of Guadalajara (Mexico). He has diplomas in university teaching, research methodology, and upper digestive surgery (Chile), a master’s degree in psychopedagogy and higher education, publishing 5 articles in different journals.

Poster Page: https://endoscopy-gi.utilitarianconferences.com/speaker/dr-pablo-segales-bautista

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