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Case Reports
. 2022 Jun 24;9(7):947.
doi: 10.3390/children9070947.

Fluorescence-Guided Surgery (FGS) during a Laparoscopic Redo Nissen Fundoplication: The First Case in Children

Irene Paraboschi  1 , Laura Privitera  1 , Stavros Loukogeorgakis  2 , Stefano Giuliani  1   2   3
Affiliations
Case Reports

Fluorescence-Guided Surgery (FGS) during a Laparoscopic Redo Nissen Fundoplication: The First Case in Children

Irene Paraboschi et al. Children (Basel). .

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.

Keywords: Nissen fundoplication; antireflux surgery; children; device; fluorescence-guided surgery; indocyanine green; near-infrared; real-time imaging; redo surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a,b) Upper gastrointestinal contrast study showing failed fundoplication and moderate hiatal hernia with reflux to the upper esophageal level.
Figure 2
Figure 2
Lysis of the dense adhesions between the liver, the stomach, and the right crus of the diaphragm. EleVisionTM IR platform (Medtronic Ltd., Hertfordshire, England) allowed for the clear visualization of a vessel hidden in the tight scar tissue between liver and stomach (arrow), and this helped in the laparoscopic adhesiolysis. (a1) Visible-light image (b1) green filter image (c1) near-infrared (NIR) image.
Figure 3
Figure 3
Exposure and easy visualization of the left gastric artery (arrow). (a1,a2) Visible-light image (b1,b1) green filter image (c1,c2) near-infrared (NIR) image.
Figure 4
Figure 4
Evaluation of the remaining vascular supply of the esophagus (arrow). (a1) Visible-light image (b1) green filter image (c1) near-infrared (NIR) image.
See this image and copyright information in PMC

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