Advance in Pediatric Surgery

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Surgery".

Deadline for manuscript submissions: closed (20 June 2023) | Viewed by 21252

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Guest Editor
Department of Pediatric Surgery, University Politecnica of Marche, Ospedale Pediatrico G. Salesi, AOU delle Marche, Via Filippo Corridoni, 11, 60123 Ancona, AN, Italy
Interests: pediatric surgery; laparoscopic surgery; robot-assisted surgery
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Guest Editor
Department of Odontostomatologic and Specialized Clinical Sciences (DISCO), Marche Polytechnic University, Pediatric Surgery Unit Salesi Children’s Hospital, 60121 Ancona, AN, Italy
Interests: minimally invasive surgery; thoracic surgery; pediatric urology; robot-assisted surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Of all the surgical specialties, pediatric surgery is the one that has perhaps evolved the most in a shorter period of time compared to the others. Since the first laparoscopic CDH repair by van der Zee (1995) until now, surgical techniques have undergone continuous improvements, up to goals that were unimaginable a few years ago, such as performing robotic-assisted surgical procedures on patients under the age of one. In addition, other types of technological innovations have come to the aid of pediatric surgeons, such as rendering programs that have facilitated not only the planning of more complex operations but have also made it easier to create simulations for the training of younger surgeons. In this Special Issue, we want to focus on all of the most important advances in pediatric surgery that have allowed us to achieve better outcomes, both in the surgical approach and the training of pediatric surgeons.

As the Guest Editors of this Special Issue, we hope that this will be an opportunity to share the experiences that you consider to be the most useful and significant in this area of pediatric surgery.

Dr. Giovanni Cobellis
Dr. Edoardo Bindi
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • minimally invasive surgery
  • laparoscopic surgery
  • laparoscopic neonatal surgery
  • thoracoscopic surgery
  • robot-assisted surgery
  • training program
  • learning curve
  • simulation
  • surgical devices

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Published Papers (11 papers)

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Research

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10 pages, 488 KiB  
Article
The Effect of Parental Beliefs on Post-Traumatic Symptoms of the Parent and Child after the Child’s Surgery
by Amichai Ben-Ari, Yael L. E. Ankri, Roy Aloni and Orly Buniak-Rojas
Children 2022, 9(8), 1265; https://doi.org/10.3390/children9081265 - 22 Aug 2022
Viewed by 1252
Abstract
In recent years, many studies have attempted to find the main predictors of the development of post-traumatic symptoms in children following medical procedures. Recent studies found a link between parental beliefs and children’s post-traumatic symptoms in various medical contexts such as life-threatening illness, [...] Read more.
In recent years, many studies have attempted to find the main predictors of the development of post-traumatic symptoms in children following medical procedures. Recent studies found a link between parental beliefs and children’s post-traumatic symptoms in various medical contexts such as life-threatening illness, pain, and hospitalization. This study aims to examine the relationship between parental beleifs and post-traumatic symptoms in children and parents after surgical interventions of the children. The study was conducted among 149 children who underwent surgery and their parents. The children and parents were examined at 2 time points- during hospitalization, and 4 months after the hospitalization. Questionnaires were administered measuring parental beleifs pertaining to parental distress, and post-traumatic symptoms among children. results show a correlation between the factors. In addition, it was found that the parents’ distress is a mediating relationship between the parents’ perceptions and the child’s level of distress. It has been found that there is a link between some of the parental beleifs and parental stress symptoms and post-traumatic symptoms in the children. Parental beliefs that were found to influence these variables were related to parental beliefs regarding children’s suffering and pain during surgery. In addition, children of parents with higher levels of religious and spiritual beliefs were found to have fewer post-traumatic symptoms. This study sheds light on parental beliefs that may have the power to influence parental stress levels and children’s post-traumatic symptoms after surgery. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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11 pages, 3769 KiB  
Article
Robotic Surgery: Is There a Possibility of Increasing Its Application in Pediatric Settings? A Single-Center Experience
by Edoardo Bindi, Camilla Todesco, Fabiano Nino, Giovanni Torino, Gianluca Gentilucci and Giovanni Cobellis
Children 2022, 9(7), 1021; https://doi.org/10.3390/children9071021 - 08 Jul 2022
Cited by 5 | Viewed by 1526
Abstract
Introduction: Robotic surgery has shown explicit benefits and advantages in adults, but it is not yet strongly established in the pediatric population, even though its popularity is increasing, especially in the urologic field. Materials and methods: In this article we present our experience [...] Read more.
Introduction: Robotic surgery has shown explicit benefits and advantages in adults, but it is not yet strongly established in the pediatric population, even though its popularity is increasing, especially in the urologic field. Materials and methods: In this article we present our experience with the Da Vinci System (SI first and XI nowadays) at our pediatric institution in order to analyze our progress over the years. We considered all patients from the start of the robotic surgery program in 2016 until the end of 2021, dividing them into general abdominal surgery and genitourinary surgery. Analyzed data were the patient’s demographic, details of surgery, and intra and post-operative complications. Results: The total number of patients (pts) included in this study was 76, of whom 40 (52%) were male and 36 (48%) were female. The mean age at surgery was 90.9 months (range 10–207 months), and the mean weight at surgery was 29.3 kg (range 9.5–68 kg). There were 18 general abdominal robotic surgeries and 58 genitourinary robotic surgeries performed. The most performed surgeries in these two categories were fundoplication for gastro-oesophageal reflux disease (11%) and Anderson–Hynes pyeloureteroplasty. The mean operative time was 224.2 min (range 72–530 min): the mean times in the two groups (general abdominal surgery and genitourinary surgery) were 165 min (range 84–204 min) and 194 min (range 95–360 min), respectively. A total of four (5%) minor complications were reported. The total conversions were two (2.6%) and the mortality rate was 0%. Conclusions: Pediatric robotic surgery is a field of considerable interest and it is rapidly expanding. In our experience, it is evident how the learning curve has increased gradually, but steadily, allowing us to advance from standardized surgery, such as fundoplication and pieloplasty, towards a more technically complex one, achieving the same good results. We believe that robotic surgery is very respectful of tissues and feasible, especially for reconstructive surgery. For these reasons, it could become of common use also in the pediatric population, overcoming impediments such as excessive cost and the lack of pediatric instruments, in order to be able to treat children with a progressively lower age and weight. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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9 pages, 2589 KiB  
Article
Management of Pediatric Facial Burns with Zinc-Hyaluronan Gel
by Aba Lőrincz, Anna Gabriella Lamberti, Zsolt Juhász, András Garami and Gergő Józsa
Children 2022, 9(7), 976; https://doi.org/10.3390/children9070976 - 29 Jun 2022
Cited by 1 | Viewed by 1586
Abstract
Zinc-hyaluronan-containing burn dressings have been associated with enhanced reepithelialization and low infection rates, although their effectiveness has not yet been investigated in pediatric facial thermal injuries. This single-arm, retrospective cohort study assessed the characteristics of 23 children (≤17-year-old) with facial superficial partial-thickness burns [...] Read more.
Zinc-hyaluronan-containing burn dressings have been associated with enhanced reepithelialization and low infection rates, although their effectiveness has not yet been investigated in pediatric facial thermal injuries. This single-arm, retrospective cohort study assessed the characteristics of 23 children (≤17-year-old) with facial superficial partial-thickness burns and the wound closure capabilities of the applied zinc-hyaluronan gel. Patients were admitted consecutively to the Pediatric Surgery Division in Pécs, Hungary, between 1 January 2016 and 15 October 2021. The mean age of the children was 6.2 years; 30.4% of them were younger than 1 year. An average of 3% total body surface was injured in the facial region and 47.8% of the patients had other areas damaged as well, most frequently the left upper limb (30.4%). The mean time until complete reepithelialization was 7.9 days and the children spent 2 days in the hospital. Wound cultures revealed normal bacterial growth in all cases and follow-up examinations found no hypertrophic scarring. In conclusion, pediatric facial superficial partial-thickness burns are prevalent during infancy and coincide with left upper limb injuries. Rapid wound closure and low complication rates are accountable for the moderate amount of hospitalization. These benefits, along with the gel’s ease of applicability and spontaneous separation, are linked to child-friendly burn care. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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Review

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14 pages, 2451 KiB  
Review
State of the Art Bowel Management for Pediatric Colorectal Problems: Spinal Anomalies
by Elizaveta Bokova, Ninad Prasade, John M. Rosen, Irene Isabel P. Lim, Marc A. Levitt and Rebecca M. Rentea
Children 2023, 10(9), 1558; https://doi.org/10.3390/children10091558 - 15 Sep 2023
Viewed by 1027
Abstract
Background: Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction. Methods: To define existing approaches and propose state-of-the-art bowel management, a literature search was performed [...] Read more.
Background: Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction. Methods: To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023. Results: Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on spinal MRI, the potential for bowel control in these children depends on age, type, and lesion level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for management include laxatives, rectal enemas, transanal irrigations, antegrade flushes, and the creation of a stoma. Approximately 22–71% of patients achieve social continence dependent on the type and level of the lesion. Conclusion: Patients with spinal anomalies require a thorough assessment for continence potential and stool burden prior to initiation of bowel management. The optimal treatment option is defined according to the patient’s age, anatomy, and mobility. The likelihood of independent bowel regimen administration should be discussed with the patients and their caregivers. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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18 pages, 2626 KiB  
Review
State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease
by Elizaveta Bokova, Ninad Prasade, Sanjana Janumpally, John M. Rosen, Irene Isabel P. Lim, Marc A. Levitt and Rebecca M. Rentea
Children 2023, 10(8), 1418; https://doi.org/10.3390/children10081418 - 20 Aug 2023
Cited by 2 | Viewed by 2404
Abstract
After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript [...] Read more.
After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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17 pages, 3464 KiB  
Review
State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation
by Elizaveta Bokova, Wendy Jo Svetanoff, John M. Rosen, Marc A. Levitt and Rebecca M. Rentea
Children 2023, 10(6), 1078; https://doi.org/10.3390/children10061078 - 19 Jun 2023
Cited by 4 | Viewed by 3469
Abstract
Background: Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on [...] Read more.
Background: Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC. Methods: A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5–10 years. Results: The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer’s procedure) can be guided with a balloon expulsion test. Conclusion: Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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13 pages, 2225 KiB  
Review
State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations
by Elizaveta Bokova, Wendy Jo Svetanoff, Joseph J. Lopez, Marc A. Levitt and Rebecca M. Rentea
Children 2023, 10(5), 846; https://doi.org/10.3390/children10050846 - 08 May 2023
Cited by 3 | Viewed by 2540
Abstract
Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part [...] Read more.
Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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14 pages, 1202 KiB  
Review
Pediatric Bowel Management Options and Organizational Aspects
by Elizaveta Bokova, Wendy Jo Svetanoff, Marc Aaron Levitt and Rebecca Maria Rentea
Children 2023, 10(4), 633; https://doi.org/10.3390/children10040633 - 28 Mar 2023
Cited by 4 | Viewed by 1975
Abstract
A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript [...] Read more.
A bowel management program (BMP) to treat fecal incontinence and severe constipation is utilized for patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and functional constipation, decreasing the rate of emergency department visits, and hospital admissions. This review is part of a manuscript series and focuses on updates in the use of antegrade flushes for bowel management, as well as organizational aspects, collaborative approach, telemedicine, the importance of family education, and one-year outcomes of the bowel management program. Implementation of a multidisciplinary program involving physicians, nurses, advanced practice providers, coordinators, psychologists, and social workers leads to rapid center growth and enhances surgical referrals. Education of the families is crucial for postoperative outcomes, prevention, and early detection of complications, especially Hirschsprung-associated enterocolitis. Telemedicine can be proposed to patients with a defined anatomy and is associated with high parent satisfaction and decreased patient stress in comparison to in-person visits. The BMP has proved to be effective in all groups of colorectal patients at a 1- and 2-year follow-up with social continence achieved in 70–72% and 78% of patients, respectively, and an improvement in the patients’ quality of life. A transitional care to adult program is essential to maintain the same quality of care, and continuity of care and to achieve desired long-term outcomes as the patient reaches adult age. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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Other

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9 pages, 7966 KiB  
Case Report
A Rare Complication of Thoracic Spine Surgery: Pediatric Horner’s Syndrome after Posterior Vertebral Column Resection—A Case Report
by Pawel Grabala, Kinga Danowska-Idziok and Ilkka J. Helenius
Children 2023, 10(1), 156; https://doi.org/10.3390/children10010156 - 13 Jan 2023
Viewed by 1678
Abstract
Background: Horner’s syndrome (HS) classically consists of the symptom triad of miosis, ptosis, and anhidrosis. It is caused by impairment of a certain pathway in the sympathetic nervous system. It may also appear as part of the clinical signs of other diseases and [...] Read more.
Background: Horner’s syndrome (HS) classically consists of the symptom triad of miosis, ptosis, and anhidrosis. It is caused by impairment of a certain pathway in the sympathetic nervous system. It may also appear as part of the clinical signs of other diseases and syndromes, including Pancoast tumors, intradural and/or epidural tumors, thoracic outlet syndrome, syringomyelia, brachial plexus injury, and aortic dissection. Here, we report a very rare complication of vertebral column resection in children, and we present the clinical findings of a case of Horner’s syndrome with a current literature review. Case presentation: A five-year-old child with severe congenital kyphoscoliosis qualified for surgical treatment of the spinal deformity via a posterior approach, with three-column osteotomy and fusion. Results: After successful surgery, the patient presented with HS due to distraction of the sympathetic nerve trunk and, thus, innervation to the left eye. At the 4-year follow-up, the child had fully recovered. Conclusions: Pediatric HS after posterior instrumented scoliosis correction surgery with posterior vertebral column resection of the thoracic spine is very rare. This is the first reported case of HS after posterior vertebral column resection and spinal fusion for congenital kyphoscoliosis without the use of epidural analgesia. Symptom resolution may be variable and, in some cases, delayed. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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6 pages, 4674 KiB  
Case Report
Pediculated Accessory Liver Lobe with Gallbladder in a Preterm with Umbilical Cord Hernia
by Martha Georgina Brandtner, Hannah N. Stundner-Ladenhauf, Sara Lapointe-Rohde, Christa Schimke, Dietrich Kluth and Roman Metzger
Children 2022, 9(11), 1754; https://doi.org/10.3390/children9111754 - 15 Nov 2022
Cited by 1 | Viewed by 1301
Abstract
(1) Background: Accessory liver lobes are a rare finding and only a few case reports of accessory liver lobes in abdominal wall defects have been reported so far. In the case of a congenital wall defect including liver parenchyma, there is still an [...] Read more.
(1) Background: Accessory liver lobes are a rare finding and only a few case reports of accessory liver lobes in abdominal wall defects have been reported so far. In the case of a congenital wall defect including liver parenchyma, there is still an ongoing debate on the definition of the abdominal wall defect and best care practice. Even though congenital abdominal wall defects are frequently diagnosed in prenatal screenings, controversy on the underlying etiology, embryology and underlying anatomy remains. Prenatal distinction between omphalocele and hernia into the cord cannot always be obtained; however, due to its clinical relevance for postnatal management and counseling of parents, accurate diagnosis is essential. (2) Case Presentation: We describe the uncommon postnatal finding of a pediculated accessory liver lobe with gallbladder in a preterm with umbilical cord hernia, which was prenatally diagnosed as omphalocele. Postnatal examination revealed an amniotic sac with a diameter of six and a small abdominal wall defect of three centimeters in diameter. Postnatal management included resection of the accessory liver lobe and gallbladder and closure of the defect. (3) Results and (4) Conclusions: Throughout the literature, the distinction between umbilical cord hernia and omphalocele has been variable. This has led to confusion and difficulties regarding postnatal treatment options. In order to achieve an accurate prenatal and/or postnatal diagnosis, the morphological differences and clinical manifestation of umbilical cord hernia and omphalocele need to be assessed. Further embryological studies are warranted to understand the underlying embryological pathology of omphalocele and umbilical cord hernia and offer appropriate treatment. In consideration of possibly severe complications in the case of the torsion of a pedunculated accessory liver lobe, we strongly recommend primary removal once pre- or intraoperative identification has been made. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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6 pages, 3985 KiB  
Case Report
Fluorescence-Guided Surgery (FGS) during a Laparoscopic Redo Nissen Fundoplication: The First Case in Children
by Irene Paraboschi, Laura Privitera, Stavros Loukogeorgakis and Stefano Giuliani
Children 2022, 9(7), 947; https://doi.org/10.3390/children9070947 - 24 Jun 2022
Cited by 5 | Viewed by 1414
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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