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Fluorescence-Guided Surgery (FGS) during a Laparoscopic Redo Nissen Fundoplication: The First Case in Children
Irene Paraboschi1, Laura Privitera1, Stavros Loukogeorgakis2
1Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London WC1E 6BT, UK.
Insights
This study details the first use of fluorescence-guided surgery (FGS) with indocyanine green (ICG) in pediatric redo-Nissen fundoplication. FGS enhanced visualization, simplifying complex procedures and potentially reducing surgical risks.
Area of Science:
- Pediatric Surgery
- Surgical Technology
- Gastroenterology
Background:
- Redo-Nissen fundoplication is complex due to adhesions from prior surgery.
- Recurrent gastroesophageal reflux symptoms necessitate reoperation.
- Standard visualization techniques can be challenging in redo anti-reflux surgery.
Observation:
- Indocyanine green (ICG) fluorescence-guided surgery (FGS) was employed in a pediatric redo-Nissen fundoplication.
- ICG administration improved visualization during adhesiolysis.
- Key structures like small esophageal vessels and the left gastric artery were identified for preservation.
Findings:
- FGS facilitated easier dissection in a complex redo fundoplication.
- The use of ICG likely reduced the risk of intraoperative complications.
- Improved visualization aids in navigating dense adhesions and protecting critical anatomy.
Implications:
- Fluorescence-guided surgery with ICG offers a valuable tool for complex pediatric abdominal redo operations.
- This technology has the potential to enhance surgical outcomes and patient safety.
- Routine adoption of FGS could be considered for challenging redo anti-reflux procedures.
Abstract:
We present the first case of fluorescence-guided surgery (FGS) using indocyanine green (ICG) in a pediatric redo-Nissen fundoplication. The patient is a 17-year-old male with recurrent gastroesophageal symptoms who underwent primary antireflux surgery at 10 months of age. During the redo fundoplication, ICG was intravenously administered to help the visualization during the adhesiolysis between liver, stomach and right crus of the diaphragm and to spare small oesophageal vessels and the left gastric artery. In this case, FGS made the surgery easier than usual and likely reduced the risk of intra-operative complications. Therefore, we believe that this new technology should be regularly used in these types of complex intra-abdominal redo operations.
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