Ileal pouch–anal anastomosis with fluorescence angiography: a case‐matched study

Aim An anastomotic leak in ileoanal pouch surgery may lead to pouch failure. Constructing a tension‐free ileal pouch–anal anastomosis ( IPAA ) reduces this risk but can be technically challenging, balancing pouch vascularization with ileal mesenteric length and site of vessel ligation. Fluorescence angiography ( FA ) may help the clinician make a more balanced judgement. Methods Thirty‐two patients undergoing minimally invasive completion proctectomy with FA ‐guided IPAA at two academic centres were matched and compared on a 1:1 basis to a historical group undergoing the same procedure without the use of this technique. Results Ligation of the ileocolic vessels was safely performed in 15/32 (47%) of FA patients compared with 5/32 (16%) of historical controls. One patient underwent intra‐operative IPAA reconstruction after FA detected ischaemia. No anastomotic leak occurred with FA but there was only one in the historical controls ( P  = 0.31). The postoperative complication rate was similar between the two groups ( P  = 0.60). Conclusion FA is applicable to IPAA surgery and may help to reduce perfusion‐related anastomotic leaks. A prospective randomized trial is warranted.