Novel use of a light-emitting nasogastric tube to enhance oesophageal dissection during laparoscopic fundoplication in children: a case report.

Abstract

Background: Laparoscopic Nissen fundoplication is the standard treatment for gastroesophageal reflux disease in children. The proper dissection of the oesophagus and the hiatus is essential yet may be associated with higher morbidities in scenarios where dense adhesions obscuring a clear tissue plane were anticipated, for instance, patients with previous laparotomies, redo-fundoplication, etc. We hereby report the first experience of the novel use of a light-emitting nasogastric tube to enhance oesophageal dissection during laparoscopic fundoplication in children.

Case description: In this case report, we report a four-year-old girl with known cystic fibrosis who required supplemental milk to improve nutrition and medications administered via a nasogastric tube. Since long-term tube feeding was expected, the patient's parents were advised of the need for gastrostomy tube insertion and a pre-operative potential of hydrogen (pH) study. The 24-hour pH study revealed significant gastroesophageal reflux; therefore, laparoscopic fundoplication and gastrostomy were planned. An infrared illumination system urethral kit was put inside a feeding tube for identification of the boundary of the intra-abdominal oesophagus and aiding dissection in real time. Laparoscopic fundoplication and gastrostomy were smoothly performed. The patient resumed feeding 1 day after the procedure and was fit for discharge 3 days after the operation.

Conclusions: Light-emitting nasogastric tube is safe and potentially facilitates oesophageal dissection during laparoscopic fundoplication in children.