Although laser Doppler flowmetry and laser fluorescence angiography are earlier described reliable methods of measuring intraoperative perfusion,17, 18, 19, 24, 31 and 32 they can be cumbersome and difficult to implement, especially during laparoscopic operations. The use of fluorescence angiography

has potential for great clinical significance Daporinad datasheet on outcomes of colorectal surgery especially with regard to high-risk anastomoses. Our data are consistent with this hypothesis by demonstrating lower anastomotic leak rates than those reported in the literature, even within the high-risk group. This result concurs with earlier reports by both Kudszus and colleagues5 and Jafari and colleagues,1 which demonstrated decreases in leak rates of 60% and 66%, respectively, when compared with a control group. Jafari and colleagues1 included a high-risk population of rectal cancer patients undergoing low anterior resection with anastomoses at a mean level of <5.5 cm from the anal verge. There was a reported 63% rate of history of radiation use in the fluorescence group. We demonstrated an anastomotic leak rate of 1.4% (n = 2), which is a promising reduction compared with that reported in the literature (12%).7 and 8 Considering the incidence of changes in the resection margin/anastomosis (n = 10) as high-risk patients who may have had leaks due to relative ischemia, it is

intriguing to note that if half of these patients had suffered leaks, the overall leak rate would have been 5%. If all Acesulfame Potassium of these Linsitinib cell line patients had leaks, the rate would have been 8.6%, putting the leak rate into an expected range for a heterogeneous group of medium- and high-risk

patients. Adequate perfusion is a key component of anastomotic integrity. To date, conventional methods have been inadequate, as demonstrated by a high rate of anastomotic failures, and almost mandatory use of diverting ileostomy for low pelvic, high risk anastomoses. These anastomotic leaks have a substantial impact on the morbidity and mortality of patients.2, 3, 13, 27, 30, 33 and 34 Therefore, any method to decrease the rate of anastomotic leak is of significant interest. Although patient-related-factors cannot be easily altered, there is potential to improve the assessment of bowel perfusion, viability, and anastomotic integrity. Our data may support the use of fluorescence angiography to allow for visualization of microperfusion of the bowel, which may, in turn, improve outcomes and decrease morbidity rates associated with anastomotic leaks. The 2 patients who developed anastomotic leaks in our series had minimal morbidity and required minimal interventions to manage the leak. This study should be viewed with certain significant limitations. As a prospective single armed study of moderate size, inherent biases exist.