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To examine the recurrence rates of pediatric benign ovarian neoplasms.A retrospective review of females up to 21 years of age who underwent surgery for a benign ovarian neoplasm at eight pediatric hospitals from January 2010 through December 2016 was conducted. Data includes primary operation details, follow-up imaging, and reoperation details.426 females were included in our cohort, with a median age of 15 years at the time of the primary operation. 69% of patients had a mature teratoma, 18% had a serous cystadenoma, and 8% had a mucinous cystadenoma. Two-thirds of patients underwent ovarian-sparing surgery. There were 11 pathologically-confirmed recurrences (2.6%) at a median follow-up of 12.8 months. The pathologically-confirmed recurrence was 10.5 per 100 person-months at 12 months (SE: 5.7) for mucinous cystadenoma and 0.4 (SE: 0.4) for mature teratoma (p=0.001). Half of patients of the pathologically-confirmed recurrences occurred by 12.8 months and 75% by 23.3 months. There were no differences in reoperation or recurrence based on initial procedure (ovary-sparing versus oophorectomy).We measured the pathologically-confirmed recurrence rate for pediatric benign ovarian neoplasms in a large cohort. Oophorectomy was not protective against recurrence. Mucinous cystadenomas were at a greater risk of pathologically-confirmed recurrence.

Background: Historically, exocrine pancreas secretions during pancreas transplant were commonly managed by bladder drainage. Although this technique has fallen out of favor because of significant rates of urologic complications, urologists must still be prepared to assist when they arise. We describe the first reported case of a cystoscopically placed pancreatic duct stent for management of a pancreas transplant duodenocystostomy leak in the setting of normal bladder function. Case Presentation: A 63-year-old male with a history of type 1 diabetes mellitus complicated by end-stage renal disease underwent a simultaneous bladder-drained pancreas and kidney transplant 25 years ago. He developed hematuria and acute rejection of his pancreas, with CT showing large volume ascites concerning for pancreatic leak. Cystoscopy revealed an intact and patent duodenal-cystostomy anastomosis; however, intraperitoneal extravasation on intraoperative cystogram raised concern for pancreatic head necrosis. The patient underwent intraperitoneal drain placement and Foley catheter bladder decompression, but drain output and drain amylase and lipase remained markedly elevated. He was taken back to the operating room for attempted cystoscopic stenting of the pancreatic duct, which was effective using a 5F × 4 cm Zimmon(®) pancreatic stent. His drain output normalized in the following days and the pancreatic stent and intraperitoneal drain were removed 4 and 5 weeks after discharge, respectively. Outpatient urodynamics revealed no signs of obstruction and his catheter was removed with minimal postvoid residuals on follow-up. Conclusion: Anastomotic leak after duodenocystostomy during pancreas transplant is a complication typically related to elevated intravesical pressures, managed with bladder decompression and subsequent bladder outlet procedure. We present a novel technique for cystoscopic pancreatic duct stenting in the setting of intact anastomosis and normal bladder function with delayed leak secondary to necrotic pancreatic head. Endoscopic stent placement, intraperitoneal drainage, and bladder decompression with Foley catheter are an effective technique to avoid unnecessary reconstructive surgery.

Introduction: Minimal esophageal mobilization during laparoscopic fundoplication decreases the rate of wrap transmigration, and previous study has shown that placement of esophageal-crural sutures ...

Background The duration of antibiotic treatment after resolution of empyema in children is variable. We evaluated the efficacy and safety of a protocol-driven antibiotic regimen aimed to decrease antibiotic duration following treatment with fibrinolysis. Methods Our institutional protocol consisted of 7 further days of antibiotics upon removal of the thoracostomy tube, with the patient being afebrile, off supplemental oxygen, and having negative cultures. A prospective observational study was then performed between September 2014 and March 2019. Empyema recurrence and antibiotic-related complications were recorded. Results were compared with previously published data from the preprotocol era. Results A total of 37 patients were included. Mean total duration of antibiotics decreased from 26 ± 6.5 days in the preprotocol group to 22 ± 9.7 days in the postprotocol group (P = 0.004). This resulted in a significant decrease in hospital stay from the preprotocol cohort to the postprotocol cohort, respectively (9.3 ± 4.8 d versus 6.8 ± 3.1 d, P = 0.003). Sixty-two percentage of the patients were intended to treat according to the protocol, with a 50% adherence rate. Patients in which the protocol was followed had an average of 2.8 fewer days of antibiotics after discharge (P = 0.004), although overall duration was not statistically different. Significantly fewer antibiotic-related complications were noted after protocol initiation. There was no difference in empyema recurrence or readmissions. Conclusions Institution of a protocol-driven approach to antibiotic duration following resolution of pleural space disease may reduce antibiotic duration and complications without reducing efficacy.

To evaluate failure of initial operative therapy (incomplete tumor removal) of ovarian-sparing surgery for pediatric benign ovarian neoplasms.A retrospective review of patients up to 21 years of age who underwent ovarian-sparing surgery for a benign ovarian neoplasm from 2010 to 2016 at 8 pediatric hospitals was conducted. Failure of initial operative therapy is defined as a radiologically suspected or pathologically confirmed ipsilateral lesion with the same pathology as the primary neoplasm within 12 weeks of the initial operation.Forty patients received imaging within 12 weeks of their primary operation. Sixteen (40%) patients had a radiologically identified ovarian abnormality ipsilateral to the primary lesion, and 5 patients were suspected to have the same lesion as their primary neoplasm. Three of the 5 patients (7.5%) underwent reoperation with pathologic confirmation of the same lesion, resulting in a pathologically confirmed failure of therapy rate of 7.5%. The other 2 patients had serial imaging that subsequently demonstrated no recurrence with lesion resolution. Age, race/ethnicity, laparoscopy vs laparotomy, presence of torsion, pathology, size of lesion, and surgeon specialty were not associated with failure of therapy.In most patients who received imaging within 12 weeks of the primary operation for resection of a benign ovarian neoplasm, ovarian-sparing surgery was successful in complete tumor removal, with a low failure of therapy rate. Selected patients with suspected failure of therapy on initial imaging could be serially monitored to determine the need for repeat surgical intervention.

Inguinal hernia repair is one of the most common operations performed by pediatric surgeons. These hernias typically present as asymptomatic or symptomatic swellings in the groin, extending into the labia in girls or the scrotum in boys. Surgical repair is indicated as these hernias do not spontaneously close and carry a risk of incarceration. We report a case of an extremely rare finding at the time of laparoscopic inguinal hernia repair in a preteen girl, highlighting the variable clinical presentation of this common condition and the laparoscopic approach to repair.