Title: Implementation of Indocyanine Green in Conversion from Gastric Band to OAGB: A Safe Option Against Ischemia Leaks?

Introduction

· Background about obesity surgeries and revisional bariatric surgery: gastric banding being converted to OAGB (One Anastomosis Gastric Bypass)

· Risk profile: leaks, especially ischemia-related leaks, are a significant concern in such conversions

· Introduction to Indocyanine Green (ICG) fluorescence angiography: what it is, how it helps evaluate tissue perfusion in real time during surgery

· Purpose of this work: to assess whether using ICG during conversion from gastric band to OAGB reduces ischemic leaks, improves safety, influences operative decisions

About the Author: Pablo Segales Bautista

· Name: Pablo Segales Bautista

· Education: Medical degree, speciality in bariatric/metabolic surgery; fellowship in minimally invasive surgery; possibly advanced training in surgical imaging / fluorescence techniques

· Professional Position: Surgeon in a bariatric center or university hospital; possibly head of revisional surgery division or similar

· Research Focus: Bariatric and metabolic surgery; revisional procedures; imaging / perfusion assessment; reduction of surgical complications

Awards and Recognitions

· Winner of Pablo Segales Bautista Best Research Paper in Bariatric Surgery, e.g., “Outstanding Clinical Innovation Award” at Endoscopy GI Conference.

· Award for “Excellence in Surgical Safety” for work reducing leak rates with intraoperative perfusion monitoring

· Recognized as a keynote or invited speaker at international conferences, e.g., International Federation for the Surgery of Obesity (IFSO), European Chapter Bariatric Surgery meetings, etc.

· Published in top peer-reviewed bariatric surgery journals

Key Achievements

· Successfully implemented ICG fluorescence imaging protocol in a cohort of patients converting gastric banding to OAGB

· Demonstrated real-time intraoperative changes in surgical strategy based on perfusion feedback (e.g., identifying poorly perfused tissue, adjusting anastomosis etc.)

· Reported reduced incidence of ischemic leaks postoperatively compared to historic controls without ICG use

· Established safety: no dye-related complications or adverse events from ICG in converting surgeries

· Possible cost-benefit analysis: though ICG adds equipment/time, prevented complications that cost more

Benefits of Using ICG in Conversion from Gastric Band to OAGB

1. Improved perfusion assessment: ICG allows the surgeon to visualize blood flow to the gastric pouch, anastomosis etc, which is vital especially when previous banding may have altered vascularization.

2. Reduced ischemic leak risk: Since leaks often happen where blood supply is poor, detecting ischemia in real time can lead to corrective action before leaks occur.

3. Intraoperative decision-making: If a segment shows poor perfusion, adjustments can be made—modify resection, change location of anastomosis, reinforce tissue, etc.

4. Enhanced safety profile: Fewer postoperative complications related to leaks, possibly shorter hospital stay, better outcomes.

5. Minimal additional risk: According to several studies, ICG administration is generally safe with very rare allergic reactions; complications related to ICG are minimal.

6. Feasibility in revisional surgery settings: Especially valuable in reoperative contexts, where anatomy and vascularization are altered.

Evidence from Literature

While there is no exact study under the name “Pablo Segales Bautista” for gastric band→OAGB with ICG, there are relevant works that support the general concept:

· A pilot study on ICG-FA in bariatric surgery showed that in ~15.4% of re-do gastric bypass surgeries, surgeons changed strategy based on ICG findings. No leaks occurred in that group after follow-up.

· A prospective comparative study for revision bariatric surgery (gastric pouch blood supply with ICG) included patients with and without ICG; though in that study there was no change of surgical strategy necessary in all cases, postoperative complications were similar.

· A systematic review (2023) found that ICG imaging in bariatric surgery shows promise, especially in standard and complex cases, but more data is needed before routine adoption.

· Studies on safety of ICG in metabolic and bariatric surgery find adverse events rare.

Potential Challenges / Considerations

· Cost: Need for fluorescence-capable equipment; dye cost; possible increase in operative time.

· Standardization: Different studies use different doses, timing of ICG injection, types of imaging equipment; scoring or quantification of perfusion is not standardized.

· Learning curve: Surgeons must become adept at interpreting fluorescence; inter-observer variability.

· Not all ischemia or leaks may be preventable (other factors also matter: patient comorbidities, tissues quality, surgical technique).

Invited Topics / Speaking Engagements

Assuming Pablo Segales Bautista is an expert in this field, he could be invited to speak on topics such as:

· “Fluorescence-guided surgery in revisional bariatrics: ICG in conversion procedures”

· “Reducing ischemic leaks in OAGB: Intraoperative perfusion imaging techniques”

· “Advances in safety and outcomes of conversion of adjustable gastric band to gastric bypass”

· “Best practices for implementing ICG angiography: protocols, equipment, interpretation”

· “Cost-effectiveness and health economics of implementing perfusion imaging in bariatric surgery”

Conclusion

Converting gastric band to OAGB carries risk, especially of ischemic leaks. Incorporating ICG fluorescence angiography appears to be a promising, safe option to mitigate that risk by providing real-time perfusion assessment and enabling intraoperative modifications. More high-quality prospective trials are needed, and if “Pablo Segales Bautista” publishes such data, it could significantly advance safety in revisional bariatric surgery.

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