Real-Time Perfusion and Leak Assessment in Bariatric Surgery: Bridging Traditional and Advanced Techniques

Abstract

This comprehensive literature review explores the efficacy of real-time perfusion and leak assessment methods in bariatric surgery, comparing traditional techniques with advanced imaging modalities. As the global incidence of obesity and related comorbidities rises, the demand for bariatric surgeries such as Roux-en-Y gastric bypass and sleeve gastrectomy has increased, along with the risk of serious complications like anastomotic and staple line leaks. Traditional intraoperative leak testing methods, including the air leak and methylene blue dye tests, are commonly employed but exhibit inconsistent sensitivity in leak detection. Intraoperative endoscopy, although underutilized, offers enhanced visualization and has been associated with reduced leak and complication rates in certain cases. Emerging technologies such as indocyanine green (ICG) fluorescence, laser speckle contrast imaging (LSCI), and hyperspectral imaging (HSI) provide real-time assessment of tissue perfusion, potentially improving surgical outcomes. ICG fluorescence enables visualization of blood flow to detect ischemia, while LSCI offers immediate, dye-free perfusion mapping, and HSI assesses tissue oxygenation without the need for contrast agents. Despite their promise, these technologies are limited by high costs, technical complexity, and varying accessibility, with current evidence insufficient to confirm their superiority over traditional methods. Future research should focus on large-scale, multicenter trials to validate these advanced techniques and refine their application in clinical practice. Integrating traditional and emerging methods may optimize intraoperative decision-making, reduce complications rates, and enhance patient outcomes in bariatric surgery.

Keywords: anastomosis; bariatric surgery; hsi; icg; leak; leak test; lsci; obesity; roux en y gastric bypass; sleeve gastrectomy.