Laparoscopic fundoplication for neurologically impaired adolescents with severe scoliosis

AbstractLaparoscopic antireflux procedure for patients with severe scoliosis is often challenging, as the esophageal hiatus lies in an extremely deep position and is frequently rotated. Reports regarding the clinical results of laparoscopic fundoplication are scarce, especially in patients with severe scoliosis. In this study, laparoscopic Nissen fundoplication was applied to seven adolescent patients aged between 19 and 29 years with neurological impairment and gastroesophageal reflux disease (GERD). The scoliosis among them was considerably severe with a median Cobb angle of 131°. Follow-up was conducted with a median period of 7.8 years. There was no intraoperative complication or recurrence of GERD. Two patients required tracheostomy, and one died due to recurrent pneumonia after fundoplication. Our experience suggested the feasibility of laparoscopic Nissen fundoplication with an arrangement of port layout even in neurologically impaired adolescents with severe scoliosis. As recurrent aspiration pneumonia can persist after fundoplication in some patients, an anti-aspiration procedure may be considered to achieve a higher quality of life

Juvenile fibroadenoma with features of phyllodes tumor showing intraductal growth and prominent epithelial hyperplasia in an 11-year-old girl

Breast tumors in children are uncommon, with the majority of them being adult-type fibroadenoma (FA). We report a case of juvenile FA (JFA) with features of a benign phyllodes tumor (PT) in an 11-year-old girl, showing very unusual intraductal/intracystic growth. The tumor was located at the outer peripheral portion of the right breast apart from the nipple. Histologically, the tumor showed extensive leaf-like papillary structures with a broad fibrous stroma, protruding into multiple contiguous cystic spaces lined by flat ductal epithelium, and closely resembled PT but the stroma of the tumor was only slightly cellular, showing no nuclear atypia and very few mitotic figures. In contrast, epithelial cells covering the fronds exhibited marked hyperplasia, forming a thick multilayered epithelium. The histology of the tumor with intracystic papillary structures and epithelial hyperplasia showed some similarities with intraductal papilloma (IDP). The mechanism of such unusual intraductal growth of fibroepithelial tumors, including FA/JFA and PT, and their possible common histogenesis with IDP are discussed

Scrotal Hydroceles not associated with Patent Processus Vaginalis in Children

Background: After the closure of patent processus vaginalis (PPV) in boys with indirect inguinal hernia (IIH) or hydrocele, large scrotal hydroceles can occur on rare occasions despite the complete occlusion of internal inguinal ring (IIR). We present some cases that may help to explain the cause of this rare occurrence. Materials: During last 14 years, six boys exhibited non-communicating large scrotal hydroceles (2 right, 1 left, 3 bilateral) among 352 children who underwent laparoscopic repair for hydroceles. Ages ranged from 7 months to 15 years with a median of 12 years. Five of them had a history of repair for hydrocele or IIH prior to the definitive surgery and one boy underwent an initial operation. Results: In all the patients, laparoscopic inspection at the definitive surgery revealed completely closed IIRs. One infant with primary hydroceles was found to have large hydroceles bulging into the peritoneal cavity. All the patients were treated with subtotal removal of the sac without any recurrence. Marked thickness of the sack walls with abundant lymph vessels was characteristic histopathological findings. Conclusions: The complete occlusion of the PPV does not always prevent the recurrence of hydrocele through alternative pathogenesis. The pathological findings of resected specimens suggested a disturbance in lymph flow in the testicular system. The subtotal removal of the sac is the treatment of choice. Diagnostic laparoscopy prior to a direct cut-down approach to the neck of the seminal cord is advisable to identify non-communicating hydroceles to avoid further impairment of lymph drainage around the IIR