title: Impact of Scoliosis on Laparoscopic Nissen Fundoplication.
abstract: OBJECTIVE
  Scoliosis, which is often associated with neurological impairment in children, sometimes makes it difficult to perform laparoscopic procedures. This study assessed the impact of scoliosis on performing laparoscopic Nissen fundoplication.
  
  
  METHODS
  Medical records and radiographic examinations of patients who underwent laparoscopic Nissen fundoplication at a single institution from 2006 to 2015 were reviewed retrospectively. Patients' data on age at surgery, height, weight, duration of pneumoperitoneum, and amount of bleeding were collected. The Cobb angle was measured using X-rays, and the direction (right or left) of the scoliotic curve was recorded. The chest compression ratio was calculated using computed tomography axial images.
  
  
  RESULTS
  Eighty-five patients were included and analyzed in this study, of which 89% were neurologically impaired. Median age, height, and weight were 120 months, 110 cm, and 17 kg, respectively. A positive correlation between age and the Cobb angle (ρ = 0.64) and a negative correlation between age and the chest compression ratio (ρ = -0.56) were observed. The right-curved scoliotic group showed significantly more bleeding than the nonscoliotic (<10°) group (P = .01; nonscoliotic, 0 mL; right curved, 7.5 mL; left curved, 0 mL). The severe scoliotic group (≥45°) showed more bleeding than the nonscoliotic group (P = .02). Neither the direction of the scoliotic curve nor scoliotic severity showed a significant difference in the duration of pneumoperitoneum.
  
  
  CONCLUSIONS
  The older the patient, the more severe their scoliosis and chest compression were. Right-curved or severe scoliosis could be risk factors for intraoperative bleeding in laparoscopic Nissen fundoplication.
authors.affiliation: 1 Department of Pediatric Surgery, The University of Tokyo Hospital , Tokyo, Japan .
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ishimaru
authors.affiliation: 1 Department of Pediatric Surgery, The University of Tokyo Hospital , Tokyo, Japan .
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sugiyama
authors.affiliation: 1 Department of Pediatric Surgery, The University of Tokyo Hospital , Tokyo, Japan .
authors.forename: Mari
authors.initials: M
authors.lastname: Arai
authors.affiliation: 1 Department of Pediatric Surgery, The University of Tokyo Hospital , Tokyo, Japan .
authors.forename: Kaori
authors.initials: K
authors.lastname: Satoh
authors.affiliation: 1 Department of Pediatric Surgery, The University of Tokyo Hospital , Tokyo, Japan .
authors.forename: Chizue
authors.initials: C
authors.lastname: Uotani
authors.affiliation: 1 Department of Pediatric Surgery, The University of Tokyo Hospital , Tokyo, Japan .
authors.forename: Masataka
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: 1 Department of Pediatric Surgery, The University of Tokyo Hospital , Tokyo, Japan .
authors.forename: Shohei
authors.initials: S
authors.lastname: Takami
authors.affiliation: 1 Department of Pediatric Surgery, The University of Tokyo Hospital , Tokyo, Japan .
authors.forename: Jun
authors.initials: J
authors.lastname: Fujishiro
authors.affiliation: 2 Saitama Children's Medical Center , Saitama, Japan .
authors.forename: Tadashi
authors.initials: T
authors.lastname: Iwanaka
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D011028:Pneumoperitoneum, Artificial / Q000706:statistics & numerical data; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000000981:diagnostic imaging*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: complication; fundoplication; laparoscopy; neurologically impaired children; scoliosis