Introduction Anastomotic leak post CRS with HIPEC is a major concern. Factors like surgical techniques, patient risks, and suture materials contribute, but the exact cause is unclear. Indocyanine green (ICG) is an IV dye aiding real-time bowel vascularity assessment.

Methods Retrospective analysis included CRS+HIPEC patients with ≥1 bowel anastomosis. Intraoperative ICG usage was compared with historical data to assess its impact on anastomotic leaks. ICG and Irillic camera were used to asses bowel perfusion and viability. Before intestinal resection, the transection line was subjectively determined by the surgical team through visual inspection and marked. 3ml of ICG (2.5 mg/ml concentration) was intravenously injected. Visual and fluorescence-guided transection lines were compared for alignment.

Conclusion/Implications ICG provides real-time identification of bowel perfusion after vascular division and delineates the line of demarcation between vascular and avascular segments. Prehabilitation, standardization of steps, immediate attention and repair of serosal tears, and thorough inspection of the bowel before closure are crucial in reducing bowel complications.