Published online May 16, 2026. doi: 10.12998/wjcc.v14.i14.118964
Revised: February 5, 2026
Accepted: March 25, 2026
Published online: May 16, 2026
Processing time: 102 Days and 6.3 Hours
Minimally invasive approaches are now established as the standard of care for the repair of many inguinal and abdominal wall hernias. Near-infrared fluorescence imaging using indocyanine green (ICG) has been widely adopted in minimally invasive surgery, enabling real-time visualisation of vascular and lymphatic anatomy. While ICG fluorescence imaging is well established for perfusion assessment and anatomical guidance in colorectal and oncological surgery, its role in hernia repair is less well defined. Evidence describing its specific applications, clinical utility, and impact on outcomes in hernia surgery remains limited.
To evaluate the role and potential clinical utility of ICG fluorescence imaging in minimally invasive inguinal and abdominal wall hernia repair.
A systematic search of PubMed/MEDLINE, EMBASE and Scopus was performed. Studies involving adult patients undergoing minimally invasive hernia repair in which intraoperative ICG was employed were included.
Seventeen studies met the eligibility criteria. The majority were single-patient case reports or small case series with methodological heterogeneity. ICG was used for: Bowel or abdominal wall perfusion and viability assessment, particularly for incarcerated/strangulated hernias, delineation of vascular/anatomical structures in inguinal hernia repair to reduce vascular injury, and lymphatic mapping to understand and potentially reduce postoperative hydrocele incidence. Dosing varied substantially, as did the timing of administration.
ICG fluorescence imaging during laparoscopic hernia repair appears safe and operationally feasible, with potential to enhance intraoperative assessment of tissue perfusion and anatomical structures. However, the current evidence base is limited to small observational studies with heterogeneous methodologies. Standardised administration and interpretation protocols, along with well-designed prospective comparative trials, are needed to determine specific clinical indications and quantify their impact on patient-centred outcomes.
Core Tip: Indocyanine green fluorescence imaging is an emerging adjunct in minimally invasive hernia repair. This systematic review synthesises 17 clinical studies and shows that intraoperative indocyanine green is feasible and has not been associated with adverse reactions, while providing real-time assessment of bowel/abdominal wall perfusion in incarcerated or strangulated hernias, improving identification of key inguinal vascular and cord structures, and enabling lymphatic mapping that may help reduce hydrocele. Evidence remains low quality and heterogeneous; standardised protocols and prospective comparative trials are needed before routine adoption.