Surgical outcomes of conventional versus indocyanine green fluorescence-guided laparoscopic cholecystectomy in acute cholecystitis: a propensity score-matched analysis

Introduction: Early laparoscopic cholecystectomy remains the gold standard for managing acute cholecystitis. Intraoperative fluorescent cholangiography using indocyanine green (ICG) has emerged as a promising technique to enhance surgical safety by improving visualization of biliary anatomy, reducing bile duct injuries, and decreasing the incidence of failed critical view of safety (CVS), thereby minimizing the need for bailout procedures. This study aimed to compare surgical outcomes, particularly the need for bailout procedures, between conventional (white-light) and ICG fluorescence-guided laparoscopic cholecystectomy in patients with acute cholecystitis. Methods: A prospective cohort of patients undergoing ICG fluorescence-guided laparoscopic cholecystectomy (n = 101, January 2023 – December 2024) was compared with a retrospective control group treated with conventional laparoscopic cholecystectomy (n = 84, January 2021 – December 2022) at the same institution. Propensity score matching (1:1 ratio) was employed to minimize selection bias and confounding variables. Results: Patients in the fluorescence-guided group had a significantly lower rate of bailout procedures compared to the conventional group. No statistically significant differences were observed between the groups in secondary outcomes, including operative time, length of hospital stay, reintervention rates, and major complications (Clavien–Dindo grade ≥ III). Binary logistic regression confirmed a significant reduction in the risk of bailout procedures with fluorescence guidance (OR = 0.05; 95% CI: 0.00–0.33), while no other covariates reached statistical significance. Conclusion: Based on our findings, the use of ICG fluorescence was associated with a reduced need for bailout procedures. Further multicenter prospective studies are necessary to validate these results and assess long-term outcomes.