AIM:This study aimed to evaluate the significance of a stepped nurse-led low anterior resection syndrome (LARS) clinic for patients. METHODS:A Nurse-Led Clinic (NLC) with a stepped intervention approach for patients with LARS was developed and implemented. An exploratory study was conducted in three hospitals to evaluate the nurse-led clinic. Adult rectal cancer patients experiencing LARS who attended the NLC were recruited via maximum variation sampling for semi-structured interviews. Thematic analysis was performed, employing researcher triangulation to enhance reliability. RESULTS:Seventeen participants were interviewed to evaluate the clinic. Participants described five characteristics: (1) presence of the nurse, (2) accessibility, (3) providing recognition, affirmation and understanding, (4) coordinating and (5) timing of the consultation. In addition, participants outlined four principal tasks: (1) providing information, (2) management of symptoms, (3) support and (4) follow-up and continuity of care. CONCLUSION:The NLC offered meaningful support by addressing patients' concerns comprehensively. It normalised the condition, empowered patients with tailored information and provided effective symptom management strategies. REPORTING METHOD:SRQR checklist.

Treatment of pelvic organ prolapse in 2025 Pelvic organ prolapse (POP) is a common, multifactorial condition. Clinical examination is often sufficient to establish the diagnosis, however additional tests can be indicated. Treatment can be considered in the presence of bothersome symptoms and may involve lifestyle changes, physical therapy, pessaries, or surgery. To date, guidelines regarding the surgical treatment of POP, particularly prolapse of the middle compartment, are limited, and based on sparse and heterogeneous literature. The decision to opt for surgery is made in consultation with the patient and depends on the severity of the prolapse, the affected compartments, the overall health of the patient and the expertise of the surgeon. A clear guideline can provide the physician with guidance in performing the appropriate procedure. At Ghent University Hospital, a vaginal surgical approach is typically preferred, unless specific indications exist where evidence supports the superiority of abdominal techniques.

BACKGROUND & AIMS:Perianal fistulation is a challenging phenotype of Crohn's disease, with significant impact on quality of life. Historically, fistulae have been classified anatomically in relation to the sphincter complex, and management guidelines have been generalized, with lack of attention to the clinical heterogenicity seen. The recent 'TOpClass classification system' for perianal fistulizing Crohn's disease (PFCD) addresses this issue, and classifies patients into defined groups, which provide a focus for fistula management that aligns with disease characteristics and patient goals. In this article, we discuss the clinical applicability of the TOpClass model and provide direction on its use in clinical practice. METHODS:An international group of perianal clinicians participated in an expert consensus to define how the TOpClass system can be incorporated into real-life practice. This included gastroenterologists, inflammatory bowel disease surgeons, and radiologists specialized in PFCD. The process was informed by the multi-disciplinary team management of 8 high-volume fistula centres in North America, Europe, and Australia. RESULTS:The process produced position statements to accompany the classification system and guide PFCD management. The statements range from the management of patients with quiescent perianal disease to those with severe PFCD requiring diverting-ostomy and/or proctectomy. The optimization of medical therapies, as well as the use of surgery, in fistula closure and symptom management is explored across each classification group. CONCLUSION:This article provides an overview of the system's use in clinical practice. It aims to enable clinicians to have a pragmatic and patient goal-centered approach to medical and surgical management options for individual patients with PFCD.

Kirberg et al. described in 2016 a one-step gastrostomy tube placement, the 'pull-introducer' technique, designed for small-for-gestational-age neonates, combining two endoscopic techniques. Nine infants (weight 3.4-8.1 kg) in our centre required a gastrostomy placement (two infants) or a combined gastrostomy placement and Nissen fundoplication (seven infants). A single-stage balloon gastrostomy was preferred in all cases because of a significant anaesthetic risk. The pull-introducer method was chosen because the commercially available one-step balloon gastrostomy gastropexy devices were considered too large. There were no immediate or long-term complications (except local infection). All nine infants were discharged from the hospital as planned. After 6 months, the balloon gastrostomy tube was replaced with a balloon button or balloon gastrostomy tube.

Anal fistula treatment remains a surgical challenge. This study focuses on the efficiency and safety of the Ligation of Intersphincteric Fistula Tract (LIFT) procedure for high intersphincteric anorectal fistulas, aiming to identify prognostic factors for success and complications. A retrospective chart review was conducted on all patients who underwent LIFT procedure at a tertiary referral hospital between January 2013 and January 2021. The primary endpoint was the success rate of fistula closure, confirmed with clinical investigation. Secondary endpoints included postoperative complications, reintervention and self-reported incontinence. Logistic regression analyses were performed for assessing prognostic factors for fistula closure and postoperative complications. Ninety-two patients were included in the study; after a median follow-up of 19.3 months, fistula closure was achieved in 71

ObjectivesSacral neuromodulation (SNM) has evolved as a therapeutic intervention for various pelvic floor dysfunctions. However, the traditional approach primarily assesses discipline-specific symptoms, potentially overlooking holistic symptom improvement. We aimed to investigate whether a more comprehensive evaluation of pelvic floor symptoms enhances the assessment of SNM’s test phase.Material and MethodsA prospective single-center trial (Optimization of Lower Urinary Tract Symptoms study) assessed SNM efficacy from March 2018 to December 2021 in patients from the urology department (UD) and colorectal surgery department (CRD) with a follow-up of 12 months. Objective and subjective outcomes were examined using diaries and patient-reported outcome measures. Statistical analyses were conducted to determine predictive factors for treatment success, expressed by the patient global impression of change. SPSS 29.0 was used.ResultsA total of 85 participants were included, displaying concomitant pelvic floor symptoms. After the first phase, significant improvements on all pelvic floor domains questionnaires were seen for both patients from UD and those from CRD. Although improvements were observed in bladder and bowel diaries, the traditional criteria for success (≥50% improvement in diary variables) did not consistently correlate with the patients' global impression of change. The absolute reductions in bother sum scores from multiple domains were significant predictors for the patients' global impression of change, outperforming discipline-specific assessments. Patients from UD benefit from both a urologic and pelvic pain symptom evaluation, and those from CRD, from both a urologic and bowel symptom evaluation.ConclusionsSNM shows positive effects across various pelvic floor domains, even beyond the primary intended indication of implantation. The rather rigid approach of patient selection of discipline-specific symptoms alone can be questioned. A more comprehensive evaluation encompassing various pelvic floor symptoms with the emphasis on subjective outcome measures could enhance SNM’s efficacy assessment during the test phase.Clinical Trial RegistrationThe Clinicaltrials.gov registration number for the study is NCT05313984.

AIM:Anal fistula is one of the most common anal diseases, affecting between 1 and 3 per 10 000 people per year. Symptoms have a potentially severe effect on a patient's quality of life. Surgery is the mainstay of treatment, aiming to cure the fistula and preserve anal sphincter function. Rectal advancement flap (RAF) is currently the gold standard treatment but has recurrence rates varying between 20% and 50% and might lead to disturbance of continence. The aim of the trial described in this work is to discover if the minimally invasive fistula tract laser closure (FiLaC™) technique could achieve higher healing rates and a better functional outcome than RAF. METHOD:We will perform a randomized prospective multicentre noninferiority study of the treatment of high trans-sphincteric perianal fistulas, comparing FiLaC™ with RAF in terms of fistula healing, recurrence rate, functional outcome and quality of life. Primary and secondary fistula healing will be evaluated at 26 and 52 weeks' follow-up. Quality of life will be evaluated using the SF-36 questionnaire, the Faecal Incontinence Quality of Life Scale questionnaire and the Vaizey score at 3, 6, 12 and 26 weeks postoperatively. CONCLUSION:High trans-sphincteric fistulas have a potentially severe effect on a patient's quality of life. Classical treatment with RAF is a time-consuming invasive procedure. The LATFIA trial aims to compare FiLaC™ with the gold standard treatment with RAF. In case of noninferiority, FiLaC™ treatment could be standardized as a first line treatment for high trans-sphincteric fistulas. Better conservation of the patient's anal sphincter function could possibly be obtained. Likewise, we will report on the postoperative quality of life when applying these two techniques.

Pelvic exenteration (PE) carries high morbidity. Our aim was to analyse the use of patient-reported outcome measures (PROMs) in PE patients. Search strategies were protocolized and registered in PROSPERO. PubMed, Embase, Cochrane Library, Google Scholar, Web of Science and ClinicalTrials.gov were searched with the terms ‘patient reported outcomes’, ‘pelvic exenteration’ and ‘colorectal cancer’. Studies published after 1980 reporting on PROMs for at least 10 PE patients were considered. Study selection, data extraction, rating of certainty of evidence (GRADE) and risk of bias (ROBINS-I) were performed independently by two reviewers. Nineteen of 173 studies were included (13 retrospective, six prospective). All studies were low to very low quality, with an overall moderate/serious risk of bias. Studies included data on 878 patients with locally advanced rectal cancer ( n  = 344), recurrent rectal cancer ( n  = 411) or cancer of unknown type ( n  = 123). Thirteen studies used validated questionnaires, four used non-validated measures and two used both. Questionnaires included the Functional Assessment of Cancer Therapy—Colorectal questionnaire ( n  = 6), Short Form Health Survey ( n  = 6), European Organization for Research and Treatment for Cancer (EORTC) Quality of Life Questionnaire C30 ( n  = 6), EORTC-CR38 ( n  = 4), EORTC-BLM30 ( n  = 1), Brief Pain Inventory ( n  = 2), Short Form 12 ( n  = 1), Assessment of Quality of Life ( n  = 1), Short Form Six-Dimension ( n  = 1), the Memorial Sloan Kettering Cancer Center Sphincter Function Scale ( n  = 1), the Cleveland Global Quality of Life ( n  = 1) or other ( n  = 4). Timing varied between studies. Whilst the use of validated questionnaires increased over time, this study shows that there is a need for uniform use and timing of PROMs to enable multicentre studies.

Intra-abdominal infections (IAI) are common in hospitalized patients, both in and outside of the intensive care unit. Management principles include antimicrobial therapy and source control. Typically, these infections are polymicrobial, and intra-operative samples will guide the targeted antimicrobial therapy. Although the use of prophylactic abdominal drains in patients undergoing abdominal surgery is decreasing, the use of drains to treat IAI, both in surgical and non-surgical strategies for abdominal infection, is increasing. In this context, samples from abdominal drains are often used to assist in antimicrobial decision making. In this narrative review, we provide an overview of the current role of abdominal drains in surgery, discuss the importance of biofilm formation in abdominal drains and the mechanisms involved, and review the clinical data on the use of sampling these drains for diagnostic purposes. We conclude that biofilm formation and the colonization of abdominal drains is common, which precludes the use of abdominal fluid to reliably diagnose IAI and identify the pathogens involved. We recommend limiting the use of drains and, when present, avoiding routine microbiological sampling.

AIM:Many patients are confronted with low anterior resection syndrome after rectal surgery. The perspectives of both healthcare professionals and patients on the impact of bowel problems may differ. This study aimed to explore experiences of healthcare professionals on how to provide, organise and optimise care for patients with low anterior resection syndrome from an interprofessional perspective.METHODS:An explorative qualitative design was used. Healthcare professionals were recruited in October 2018 in one general teaching hospital and one university hospital. Twenty one healthcare professionals from different professions caring for patients with low anterior resection syndrome were included in three focus group interviews.RESULTS:Healthcare professionals confirmed a lack of focus on patients who are confronted with low anterior resection syndrome and stated a need for a standardised approach of care. Additionally, three levels for care optimization emerged from the data: information before surgery with strong emphasis on the timing of informing, counselling of patients when confronted with low anterior resection syndrome and organisation of care.CONCLUSIONS:Healthcare professionals find it important to adopt the moment and amount of information to the coping mechanism and timing of the trajectory. Counselling and follow-up of patients with LARS should be organised proactively and should not remain restricted to pharmacological and nutritional advice. A possible strategy is to develop and implement late effects nurse-led clinics coordinated by the clinical nurse specialist.

Button battery (BB) ingestion is a preventable pediatric health hazard with important morbidity and mortality due to complications. We present 3 pediatric patients with a complicated course after BB ingestion and discuss current guidelines. Urgent endoscopic removal is necessary for every BB impacted in the esophagus. A new strategy before endoscopic removal is the administration of honey or sucralfate. During endoscopy, rinsing the esophageal mucosae with acetic acid can neutralize the alkalic environment and prevent late complications. Prevention of ingestion needs to be pursued by increasing awareness and changing legislation of packaging of BB.

Pelvic exenteration (PE) carries high morbidity. Our aim was to analyse the use of patient‐reported outcome measures (PROMs) in PE patients.

Many patients are confronted with low anterior resection syndrome after rectal surgery. The perspectives of both healthcare professionals and patients on the impact of bowel problems may differ. This study aimed to explore experiences of healthcare professionals on how to provide, organise and optimise care for patients with low anterior resection syndrome from an interprofessional perspective. An explorative qualitative design was used. Healthcare professionals were recruited in October 2018 in one general teaching hospital and one university hospital. Twenty one healthcare professionals from different professions caring for patients with low anterior resection syndrome were included in three focus group interviews. Healthcare professionals confirmed a lack of focus on patients who are confronted with low anterior resection syndrome and stated a need for a standardised approach of care. Additionally, three levels for care optimization emerged from the data: information before surgery with strong emphasis on the timing of informing, counselling of patients when confronted with low anterior resection syndrome and organisation of care. Healthcare professionals find it important to adopt the moment and amount of information to the coping mechanism and timing of the trajectory. Counselling and follow-up of patients with LARS should be organised proactively and should not remain restricted to pharmacological and nutritional advice. A possible strategy is to develop and implement late effects nurse-led clinics coordinated by the clinical nurse specialist.

Aim The aim of this study was to search for any association between demographic, clinical, and therapeutic characteristics of patients with a low-type anorectal malformation (ARM) and their long-term bowel function. Methods In this retrospective study, 108 patients were contacted, of which 80 patients (74%) were included. Demographic, clinical, and therapeutic information was obtained from the patients’ medical records. The standardized Rintala questionnaire (resulting in a bowel function score (BFS)) was used to evaluate bowel function. Data was analyzed with SPSS 26 (significance level = 0.050). Results 80 patients (21 boys (26.3%)) were included, 70 (87.5%) presented with a rectoperineal fistula, 9 (11.3%) with a rectovestibular fistula, and 1 (1.2%) with anus imperforatus. The Mann-Whitney U test showed a significant negative impact of trimming of the anorectum (p = 0.003) and the presence of a developmental disorder (p = 0.013) on bowel function. Patients with sacral/spinal anomalies also showed a negative trend on the BFS score (p = 0.086), but was not significant probably due to a small patient group. The other characteristics (sex, prematurity, time of diagnosis, preoperative interventions, dehiscence, time of operation, and ARM type) were not significant. Multiple linear regression confirmed these results. Conclusions Trimming and the presence of a developmental disorder have a significant negative impact on the bowel function of patients with a low-type ARM. A negative trend was observed in patients with sacral/spinal anomalies. These results may help the clinician in determining the prognosis for patients with low-type ARM, and, if confirmed by later studies, may result in a different surgical approach.

BACKGROUND:Pelvic floor dysfunctions (PFD) are prevalent conditions in primary care practice. Basic knowledge of second-line therapies among primary care providers (PCPs) is indispensable to well-inform refractory patients and improve their access to specialized care. OBJECTIVES:Getting insight into the extent of knowledge about second-line therapies for refractory PFD among PCPs in Flanders, Belgium. METHODS:From January to March 2019 Flemish PCPs participated in the OptiLUTS trial - Part A (EC/2018/0244), by the completion of a 22-item online Dutch questionnaire. Prevalence of PCPs having awareness about sacral neuromodulation (SNM), intradetrusor botulinum toxin injections (BTX) and percutaneous tibial nerve stimulation (PTNS) was explored. Descriptive statistics, univariate analyses, and multiple logistic regression analyses were performed. RESULTS:Sixty PCPs, 55% GPs, 45% GP trainees, median age 29 years, participated. Respectively, 90, 73 and 5% had ever heard about BTX, SNM and PTNS. The profession was an independent predictive factor for never having heard of SNM therapy, GPs being more likely to have a lack of knowledge than trainees (OR = 29, 95%CI [1.9-442.5]). Ninety-three percent want to learn more about these therapies. CONCLUSION:There is a margin for improvement in the knowledge of PCPs regarding therapies for refractory PFD. Awareness among PCPs should be increased for the optimization of patient care.

Aim:: I. To describe the number of false positive cases (FP), their characteristics and reason of occurrence in sacral neuromodulation therapy (SNM). Methods:: A multidisciplinary prospective single-centre study was conducted between March 2018 and December 2021 with a follow-up of 12 months. Patients with therapy-resistant pelvic organ dysfunctions, scheduled for a 2-staged SNM procedure at the Urology (UD) and Colorectal Surgery Department (CRD), were included. All patients completed bowel and bladder diaries at baseline and during the test phase. Patient global impression of change (PGIC) and satisfaction scores concerning urological (US) and bowel symptoms (BS) were surveyed at baseline, at 1, 6 and 12 months after implantation. Patient characteristics and diary outcomes between FP and true positive cases (TP) were compared using non-parametric statistical tests. SPSS 27.0 was used. Clinical trial registration: NCT05313984. Results:: The FP ratio at one month follow-up was 16% (11/68), with a FP ratio of 13% (N=6/48) and 25% (N=5/20) for the urology patients and colorectal surgery patients, respectively. There were no significant differences in demographic characteristics between the FP and TP group (p > 0,05), however there is a trend towards FP having worse baseline symptoms than TP. The FP group had a significant lower baseline and test phase 24 h diuresis (p < 0,05), without having a significant different intake than the TP group. Conclusion:: At one month after full implantation of a sacral neuromodulator, 16% of the patients showed loss of subjective success. These FP could not be predicted from demographic characteristics, most likely due to the small study population. Although not significant, FP seem to have worse symptoms at baseline than TP, with a significant lower diuresis regardless of fluid intake.

To the Editor: Considering the surgical excisional treatment of symptomatic prolapsing hemorrhoids, a recent network metaanalysis performed by Simillis et al1 showed benefits using the bipolar vessel–sealing instrument LigaSure (Valleylab, Boulder, CO) or the ultrasound Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) in terms of reduction in complications and improved efficiency in comparison with the classical hemorrhoidectomy. However, no improved efficacy was noted. Thunderbeat (Olympus, Tokyo, Japan) is a novel instrument that combines bipolar energy, assuring reliable vessel sealing, and ultrasound energy, providing fast and precise cutting and dissection of tissue, thereby making sealing and cutting tissue possible in a single step. In a small pilot trial of 36 patients (mean age = 51.4 years), we investigated the feasibility, safety, and efficacy of this instrument for excisional hemorrhoidectomy. Outcomes were evaluated during 2 follow-up visits, respectively, at a mean of 34 days and 81 days after surgery, and by means of a questionnaire, of which the mean follow-up time was 20 months. Patients’ baseline status and follow-up outcomes are summarized in Table 1. Twenty-five (69%) patients had undergone prior day-case treatments and 5 (14%) an operation, of which 2 patients received a hemorrhoid artery ligation procedure, 2 a hemorrhoidectomy, and one a hemorrhoidopexy. Ten (27.8%) patients had anemia preoperatively. Median operating time of complete pedunculated, excisional hemorrhoidectomy was 20 minutes, and during 12 (33.3%) interventions, additional hemostasis was needed. No immediate postoperative urinary retention developed in any patient, nor did any single patient present with severe 14 days 908381 SRIXXX10.1177/1553350620908381Surgical InnovationHeyerick et al letter2020

INTRODUCTION/BACKGROUND:The management of therapy-resistant lower urinary tract symptoms (LUTS) and symptoms resulting from pelvic organ dysfunctions are subject to a high variability in the Belgian health-care centres. Practical guidelines and standardized patient clinical care pathways are often lacking and unadapted to the Belgian healthcare system. OBJECTIVES:The OptiLUTS trial aims to improve the multidisciplinary care of therapy-resistant symptoms of the pelvis in the Belgian healthcare setting. Project A aims for the improvement of knowledge of 2nd line treatments for LUTS among general practitioners. In project B a treatment algorithm for the overactive bladder syndrome and non-obstructive urinary retention will be developed specifically for Belgium. In Project C a patient customized sacral neuromodulation (SNM) care pathway will be set up. METHODS:Part A: Explorative study among general practitioners by distribution of a  questionnaire. Part B: Review of existing guidelines and use of the Delphi method to obtain expert consensus. Part C: A single center comparative study to compare outcomes before and after implementation of the SNM care pathway. Patients scheduled for the first stage of Interstim therapy™ will be included (N=100). Primary endpoints are the sensitivity and specificity of a new pelvic symptom assessment tool, the conversion to implant and explantation rates. CONCLUSION:There is a margin for improvement in the care process of patients with therapy-resistant symptoms of the pelvis in the Belgium healthcare system. In the OptiLUTs trial adapted guidelines and a clinical care pathway will be developed to standardize and increase the efficiency of care. TRIAL REGISTRATION:Approval for the trial by the Ethics Committee of the Ghent University hospital: EC/2018/0244.

Abstract Aim The aim of this review was to evaluate feasibility and effectiveness of Indocyanine green fluorescence angiography (ICGA) as an assessment tool for gastric tube (GT) perfusion during the construction of the esophago-gastric anastomosis, and as a predictor of anastomotic leakage (AL). Moreover, attention was given to attempts made to quantify this method in esophageal surgery. Background & Methods After an esophagectomy, a GT is most commonly used to restore continuity of the upper gastrointestinal tract. Esophago-gastric anastomoses are known for their complications such as AL, associated with high morbidity and mortality. Graft perfusion is an important predictor for anastomotic integrity. Tissue perfusion assessment is currently based on subjective parameters as tissue color and vessel pulsations. Near infrared fluorescent (NIRF) imaging is an emerging medical imaging modality, requiring penetrating NIR light that excites a NIRF agent within the tissue, generating fluorescence that can then be captured by adapted cameras. Indocyanine green Angiography (ICGA) is such a NIRF imaging technique which can be used as a method to visualize anastomotic perfusion. For this review, 2 reviewers independently searched Pubmed and Embase for studies evaluating intraoperative ICGA perfusion assessment of the GT. Feasibility, complications, intraoperative surgical changes based on ICGA findings, quantification attempts, anatomical data and the impact of ICGA on postoperative anastomotic complications were documented and further analyzed. Results Nineteen studies were included for qualitative analyses. All described ICGA as a safe and easy method for gastric graft perfusion assessment. AL occurred in 13.8% of the entire cohort, 10% in the ICG guided group and 20.6% in the control group (p<.001). AL in the well-perfused group was 6.3% vs. 20.5% in the control group without ICGA (p< .001). The group with an altered surgical plan based on the ICG image had similar AL rates as the well perfused group (6.5% vs. 6.3%) and significantly less than the poorly perfused group (47.8%) (p<.001), suggesting that the technique is able to identify and alter a potential bad outcome. Conclusion the present review suggest that ICGA is a safe and easy method for GT perfusion assessment. Differences in AL rate between the well perfused and poor perfused anastomotic sites suggest that a good fluorescent signal is a predictor of good outcome.

BACKGROUND:After an esophagectomy, the stomach is most commonly used to restore continuity of the upper gastrointestinal tract. These esophago-gastric anastomoses are prone to serious complications such as leakage associated with high morbidity and mortality. Graft perfusion is considered to be an important predictor for anastomotic integrity. Based on the current literature we believe Indocyanine green fluorescence angiography (ICGA) is an easy assessment tool for gastric tube (GT) perfusion, and it might predict anastomotic leakage (AL).AIM:To evaluate feasibility and effectiveness of ICGA in GT perfusion assessment and as a predictor of AL.METHODS:This study was designed according to the PRISMA guidelines and registered in the PROSPERO database. PubMed and EMBASE were independently searched by 2 reviewers for studies presenting data on intraoperative ICGA GT perfusion assessment during esophago-gastric reconstruction after esophagectomy. Relevant outcomes such as feasibility, complications, intraoperative surgical changes based on ICGA findings, quantification attempts, anatomical data and the impact of ICGA on postoperative anastomotic complications, were collected by 2 independent researchers. The quality of the included articles was assessed based on the Methodological Index for Non-Randomized Studies. The 19 included studies presented data on 1192 esophagectomy patients, in 758 patients ICGA was used perioperative to guide esophageal reconstruction.RESULTS:The 19 included studies for qualitative analyses all described ICGA as a safe and easy method to evaluate gastric graft perfusion. AL occurred in 13.8% of the entire cohort, 10% in the ICG guided group and 20.6% in the control group (P < 0.001). When poorly perfused cases are excluded from the analyses, the difference in AL was even larger (AL well-perfused group 6.3% vs control group 20.5%, P < 0.001). The AL rate in the group with an altered surgical plan based on the ICG image was 6.5%, similar to the well perfused group (6.3%) and significantly less than the poorly perfused group (47.8%) (P < 0.001), suggesting that the technique is able to identify and alter a potential bad outcome.CONCLUSION:ICGA is a safe, feasible and promising method for perfusion assessment. The lower AL rate in the well perfused group suggest that a good fluorescent signal predicts a good outcome.