Our Summary

This research looked into using a method called near-infrared fluorescence imaging (NIRFI) to help surgeons decide how much of the intestine to remove in patients suffering from radiation intestinal injury (RII), a condition that can cause intestinal obstruction and requires part of the intestine to be cut out.

In the study, ten patients who had more than 100 cm of their small intestine removed were analyzed. They were treated at Jinling Hospital between October 2014 and January 2015. The surgeons used the Novadaq SPY Intra-operative Imaging System to capture and view fluorescent images of the intestines.

This procedure involved injecting a substance called indocyanine green (ICG) into the patients’ veins and using the NIRFI imaging system to observe the diseased areas of the intestine. The surgeons then decided how much of the intestine to remove based on the color, thickness, and swelling of the affected parts.

The findings showed that using NIRFI imaging helped surgeons to accurately identify and remove the affected portions of the intestine. The average length of small intestine removed was 185 cm.

After surgery, six patients only had the diseased part of their ileum (part of the small intestine) removed and preserved the ileocecal flap, an important part of the intestine. There were no serious complications after the surgery like leakage or bleeding at the surgical join, or chronic intestinal failure such as short bowel syndrome.

Patients remained in the hospital for an average of 32 days and the average cost of the hospital stay was 142,000 RMB, which was largely used for nutritional support treatment during the operation period.

After five years, none of the patients had recurrence of the disease, and CT scans and gastrointestinal angiography showed no thickening of the intestinal wall or narrowing of the lumen (the inside space of a tubular structure like an artery or intestine).

This study suggests NIRFI imaging is a helpful tool for surgeons to determine how much of the intestine needs to be removed in patients with RII.

FAQs

  1. What is near-infrared fluorescence imaging (NIRFI) and how does it aid in intestinal resection?
  2. What were the results from this study and how did the use of NIRFI imaging impact the outcomes of the surgeries?
  3. What is the average cost and length of hospital stay for patients who undergo this procedure?

Doctor’s Tip

A doctor might tell a patient undergoing intestinal resection to ask about the possibility of using near-infrared fluorescence imaging (NIRFI) during the surgery. This technology can help the surgeon accurately identify and remove only the affected parts of the intestine, potentially reducing the amount of healthy tissue that needs to be removed. This can lead to better outcomes and a lower risk of complications after surgery. It’s always important to discuss all available options with your healthcare provider before undergoing any procedure.

Suitable For

Patients who are typically recommended intestinal resection include those suffering from conditions such as radiation intestinal injury, inflammatory bowel disease, bowel obstruction, tumors, or severe infections. These patients may experience symptoms such as abdominal pain, bloating, diarrhea, vomiting, weight loss, and blood in the stool. In severe cases, surgery may be necessary to remove the affected portion of the intestine to alleviate symptoms and prevent complications.

Timeline

Overall, the timeline for a patient before and after intestinal resection would include:

  • Pre-surgery: Patients experience symptoms of radiation intestinal injury, such as intestinal obstruction, which leads to the need for surgery. They undergo consultations with surgeons and undergo tests to determine the extent of the damage.

  • Surgery: The surgeons use NIRFI imaging with ICG to identify and remove the affected parts of the intestine. The average length of small intestine removed is 185 cm.

  • Post-surgery: Patients recover in the hospital for an average of 32 days, with the majority of the cost going towards nutritional support treatment. There are no serious complications after surgery, and patients are monitored for any signs of recurrence of the disease.

  • Long-term follow-up: After five years, patients show no signs of disease recurrence, and imaging tests confirm the success of the surgery in preserving the integrity of the intestine.

Overall, the use of NIRFI imaging in intestinal resection surgery for RII patients shows promising results in improving surgical outcomes and long-term patient outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about intestinal resection include:

  1. How will the decision be made on how much of my intestine needs to be removed?
  2. What are the potential risks and complications of intestinal resection surgery?
  3. How long is the recovery process after intestinal resection surgery?
  4. Will I need to make any changes to my diet or lifestyle after the surgery?
  5. What follow-up care will be needed after the surgery?
  6. Are there any alternative treatments or procedures that could be considered instead of intestinal resection?
  7. How will my quality of life be affected after intestinal resection surgery?
  8. What is the long-term outlook for patients who undergo intestinal resection surgery?
  9. Are there any specific factors or conditions that may impact the success of the surgery in my case?
  10. Will I need to undergo any additional imaging or tests before the surgery to help determine the extent of the intestinal resection needed?

Reference

Authors: Mao Q, Yao DH, Li YS, Li JS. Journal: Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Aug 25;23(8):752-756. doi: 10.3760/cma.j.cn.441530-20200517-00284. PMID: 32810946