White Light With Icg Mode as a Technical Resource in Urgente Surgery: Intestinal Hernia Secondary to Gastrectomy

Aim Urgent esophagogastric procedures are a complex field even in expert hands; even more so is the second procedure in cases of reinterventions. For this reason, it is important to apply safe techniques to minimize the clinical risk of unwanted events. Image-guided surgery based on indocyanine green fluorescence (ICG) has gained strength in recent years thanks to its widespread use. The combination of a white light probe along with the ICG mode of the tower facilitates the identification and safe dissection of structures during revisional surgery. Methods We present a case report. Results 58-year-old man with a history of total Roux-Y gastrectomy for distal esophageal adenocarcinoma, with anastomotic leak and need for endoscopic stent, uncomplicated posterior hernia and adequate follow-up at home. Consultation 5 months later due to chest pain and dyspnea for 48 hours. CT scan showed a giant paraesophageal hernia with signs of strangulation. An urgent laparoscopic surgical intervention was decided upon with the discovery of a large volume of herniated jejunal loops that could be reduced after chelotomy. The use of the device allows us to safely visualize the path of the esophagus and the anastomosis, for correct and safe adhesion and reduction. Finally, a raffia of the pillars and a pexy of the jejunum loop of the anastomosis to the crura are performed. After 6 days of hospitalization, he was discharged without complications. Conclusion The use of the white light probe with the intraoperative ICG mode, provides greater safety during the procedure, thus being a surgical technical resource.