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Delgado-Miguel C, Camps J, Hernandez Oliveros F. The Role of Indocyanine Green in Pediatric Gastrointestinal Surgery: Systematic Review. Eur J Pediatr Surg 2024; 34:2-8. [PMID: 37406677 DOI: 10.1055/a-2123-5433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The use of near-infrared fluorescence imaging with indocyanine green (ICG) is actually considered as a very useful tool in decision-making strategy during challenging surgical procedures with a growing evidence in the literature. Our aim is to perform a systematic review focusing on ICG applications in gastrointestinal surgery. We conducted a systematic review with narrative synthesis in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Medline, and EMBASE databases to identify articles describing the gastrointestinal perioperative use of ICG in children. We extracted data on study design, demographics, surgical indications, ICG dose, and perioperative outcomes. Eleven articles, including 94 pediatric patients, from 2013 to 2022 met the inclusion criteria for narrative synthesis in our systematic review, of which 6/11 (54.5%) were case reports, 4/11 (36.4%) were retrospective studies, and 1/11 (0.1%) were case series. Current clinical applications of ICG in gastrointestinal pediatric surgery included: esophagogastric surgery in 4/11 articles (36.4%), intestinal and pancreatic surgery in 3/11 articles (27.2%), and colorectal surgery in 4/11 articles (36.4%). ICG fluorescence in gastrointestinal pediatric surgery is a promising and safe technology that facilitates intraoperative localization of anatomical structures to achieve a more precise dissection and avoid injury to other adjacent tissues. It can be considered as a meaningful tool for assessing intestinal viability, as it provides objective data on tissue perfusion, and can impact the intraoperative decision in reconstructive surgeries requiring anastomosis. Future studies are needed to confirm these initial promising results. The lack of comparative and prospective studies is still the main limitation.
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Affiliation(s)
- Carlos Delgado-Miguel
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States
| | - Juan Camps
- Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, South Carolina, United States
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Suresh G, Pandey V, Nandan R, Kachhap S. Distal duodenal web with malrotation: An unusual finding. Trop Doct 2024; 54:76-79. [PMID: 37796942 DOI: 10.1177/00494755231205628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The most common site of the congenital duodenal web is the second part. Web distal to the second part of the duodenum is rare. It mimics the windsock deformity. Diagnosis may be missed if accompanying malrotation is present. We hereby report two cases of distal duodenal webs associated with malrotation and challenges in their diagnosis and management.
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Affiliation(s)
- Greeshma Suresh
- Senior Resident, Pediatric Surgery, IMS-BHU, Varanasi, Department of Pediatric Surgery, IMS-BHU, Varanasi, Uttar Pradesh, India
| | - Vaibhav Pandey
- MCh Pediatric Surgery, Associate Professor, IMS-BHU, Varanasi, Department of Pediatric Surgery, IMS-BHU, Varanasi, Uttar Pradesh, India
| | - Ruchira Nandan
- MCh Pediatric Surgery, Assistant Professor, IMS-BHU, Varanasi, Department of Pediatric Surgery, IMS-BHU, Varanasi, Uttar Pradesh, India
| | - Seth Kachhap
- Senior Resident, Pediatric Surgery, IMS-BHU, Varanasi, Department of Pediatric Surgery, IMS-BHU, Varanasi, Uttar Pradesh, India
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Li S, Jin Y, Zhao Y, Huang J. Development of a Modified Duodenum Traction Technique in Laparoscopic Duodenal Web Excision. J Laparoendosc Adv Surg Tech A 2023; 33:909-913. [PMID: 37256714 DOI: 10.1089/lap.2022.0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Introduction: Laparoscopic duodenal web resection surgery remains safe in neonates. The pearls in laparoscopic duodenal web excision are a proper and stable duodenal exposure. Herein, we present a modified duodenal traction technique, which can improve operative field exposure in laparoscopic surgery. Material and Methods: This modified technique was performed in 54 patients during laparoscopic duodenal web resection surgery at our center. It was performed using a 5-0 PDS-II suture, which was introduced percutaneously at 1-2 cm under either side of the costal margin at the anterior axillary line, respectively, to retract the duodenum. Results: Perioperative data of these patients and short-term follow-up data of duodenal web patients were retrospectively reviewed. All 54 procedures were completed without conversion to open surgery or requiring additional ports. Patients' mean age at surgery was 5 days (range 2-30 days), and the median weight at the time of surgery was 3.25 kg (range 2.52-3.88 kg). Eight patients (14.8%) had complete membranes, whereas 46 (85.2%) had a membrane with a hole. The mean time required for this technique was 336 (range 216-416) seconds and the mean duration of the entire surgery was 77 (range 65-89) minutes. The mean postoperative hospital stay was 16 (range 9-90) days and no postoperative complication related to the suspension procedure occurred. Conclusion: Our outcomes demonstrated the modified duodenal traction technique is a feasible and ideal method during laparoscopic duodenal web resection surgery.
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Affiliation(s)
- Shuangshuang Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yuyan Jin
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yong Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Preziosi A, Paraboschi I, Giuliani S. Evaluating the Development Status of Fluorescence-Guided Surgery (FGS) in Pediatric Surgery Using the Idea, Development, Exploration, Assessment, and Long-Term Study (IDEAL) Framework. CHILDREN 2023; 10:children10040689. [PMID: 37189938 DOI: 10.3390/children10040689] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
Fluorescence-guided surgery (FGS) is used in many pediatric subspecialties but there are currently no standard guidelines or outcome data. We aimed to assess the current status of FGS in pediatrics using the Idea, Development, Exploration, Assessment, and Long-term study (IDEAL) framework. Clinical papers on FGS in children published from January 2000 to December 2022 were systematically reviewed. The stage of research development was measured considering seven fields of application: biliary tree imaging, vascular perfusion for gastrointestinal procedures, lymphatic flow imaging, tumor resection, urogenital surgery, plastic surgery, and miscellaneous procedures. Fifty-nine articles were selected. For each field of application, the overall IDEAL stage was determined to be 2a for biliary tree imaging (10 publications, 102 cases), 1 for vascular perfusion for gastrointestinal procedures (8 publications, 28 cases), 1 for lymphatic flow imaging (12 publications, 33 cases), 2a for tumor resection (20 publications, 238 cases), 2a for urogenital surgery (9 publications, 197 cases), and 1-2a for plastic surgery (4 publications, 26 cases). One report did not belong to any categories. FGS in children is still in an early phase of adoption and development. We recommend using the IDEAL framework as a guide and suggest developing multicenter studies to define the standard guidelines, effectiveness, and outcomes.
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Affiliation(s)
- Alessandra Preziosi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milano, Italy
- Cancer Section, Developmental Biology and Cancer Programme, UCL, Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Irene Paraboschi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milano, Italy
- Cancer Section, Developmental Biology and Cancer Programme, UCL, Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Stefano Giuliani
- Cancer Section, Developmental Biology and Cancer Programme, UCL, Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London W1W 7TY, UK
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Zhao J, Zhang Y, Jin Y, Li S, Liao J, Zhao Y, Chen Y, Huang J. Exploratory application of indocyanine green quantification in biliary atresia observational study. Photodiagnosis Photodyn Ther 2022; 39:102960. [PMID: 35691562 DOI: 10.1016/j.pdpdt.2022.102960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Indocyanine green (ICG) is known to facilitate real-time imaging of the bile outflow during the Kasai procedure. This study explored more possibilities for applying ICG quantification in biliary atresia (BA). METHODS We enrolled nine BA patients in this study. All patients received intravenous ICG injections before surgery and underwent Kasai operation. With a fluorescence imaging system (Nanjing Nuoyuan, REAL-IGS FLI-108) to observe the ICG and quantify the ICG fluorescence intensity (ICG-FI) changes of the hepatic portal fibrous tissue and the liver during the operation. As a short-term prognosis assessment, we monitored the postoperative ICG metabolism time in stool and used the jaundice-free (TBIL < 2 mg/dl) at 1-3 months after the operation. RESULTS The average age of the patients at the time of surgery was 73 days. There were no adverse reactions after ICG injection. All patients were observed ICG-FI increased after the dissection of hepatic portal fibrous tissue, and the ICG-FI of the liver decreased during the operation. They all received standardized treatment after surgery. Four patients completely metabolized ICG within about two weeks (no fluorescence detected in stool), and the other five were longer than two weeks. Five patients achieved a jaundice-free outcome in the short-term postoperatively, and the other four did not. CONCLUSIONS It is feasible to quantify ICG-FI in real-time to evaluate the anatomical degree of hepatic portal fibrous tissue in BA. The variations of ICG-FI in the liver and postoperative ICG metabolism time may be related to prognosis.
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Affiliation(s)
- Jiawei Zhao
- Department of Neonatal Surgery, Neonatal Center, Beijing Children Hospital, Capital Medical University, 56 Nanlishi Road, Beijing 100045, China
| | - Yanan Zhang
- Department of Neonatal Surgery, Neonatal Center, Beijing Children Hospital, Capital Medical University, 56 Nanlishi Road, Beijing 100045, China
| | - Yuyan Jin
- Department of Neonatal Surgery, Neonatal Center, Beijing Children Hospital, Capital Medical University, 56 Nanlishi Road, Beijing 100045, China
| | - Shuangshuang Li
- Department of Neonatal Surgery, Neonatal Center, Beijing Children Hospital, Capital Medical University, 56 Nanlishi Road, Beijing 100045, China
| | - Junmin Liao
- Department of Neonatal Surgery, Neonatal Center, Beijing Children Hospital, Capital Medical University, 56 Nanlishi Road, Beijing 100045, China
| | - Yong Zhao
- Department of Neonatal Surgery, Neonatal Center, Beijing Children Hospital, Capital Medical University, 56 Nanlishi Road, Beijing 100045, China
| | - Yongwei Chen
- Department of Neonatal Surgery, Neonatal Center, Beijing Children Hospital, Capital Medical University, 56 Nanlishi Road, Beijing 100045, China
| | - Jinshi Huang
- Department of Neonatal Surgery, Neonatal Center, Beijing Children Hospital, Capital Medical University, 56 Nanlishi Road, Beijing 100045, China.
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