Intraoperative use of NIRF following iatrogenic injury and reconstruction of the right gastroepiploic artery during esophagectomy: a case report

Introduction and importance: Preservation of the right gastroepiploic artery is essential for adequate gastric conduit perfusion during esophagectomy, reducing ischemia-related complications. This case report uniquely demonstrates successful intraoperative reconstruction by using quantification of near-infrared fluorescence imaging, contributing objective insight into vascular salvage and perfusion assessment in complex esophageal surgery. Presentation of a case: A 48-year-old patient underwent a transthoracic McKeown esophagectomy with gastric conduit reconstruction for esophageal adenocarcinoma. During the procedure, iatrogenic injury to the right gastroepiploic artery occurred, necessitating direct vascular reconstruction. Intraoperative near-infrared fluorescence angiography was utilized both before and after the repair to evaluate and verify restoration of perfusion. Clinical discussion: Quantitative analysis of near-infrared fluorescence imaging showed improved perfusion parameters and correlated with a favorable clinical outcome. Despite an initial poor signal, the patient remained free of ischemia-related complications and was discharged on postoperative day 7. Conclusion: This case report highlights the potential of near-infrared fluorescence imaging to improve the outcome of management of injury of the right gastroepiploic artery during esophagectomy. It hereby supports its broader use in intraoperative decision-making during complex gastrointestinal surgery.