Language：English  

DOI： 10.1002/jhbp.1381

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DOI： 10.1111/hepr.13976

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DOI： 10.1007/s00595-023-02757-y

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DOI： 10.1186/s40792-023-01754-0

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DOI： 10.1007/s00383-023-05548-1

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Language：English  

DOI： 10.1016/j.jpedsurg.2022.11.018

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PubMed

Publisher：東京医学社  

DOI： 10.24479/ps.0000000514

CiNii Research

Language：English  

DOI： 10.1186/s12887-023-04190-z

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PubMed

Language：English  

DOI： 10.3389/fped.2023.1220393

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Language：English  

DOI： 10.3389/fped.2023.1149515

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PubMed

Language：English  

DOI： 10.12659/AJCR.938723

PubMed

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Publisher：東京医学社  

DOI： 10.24479/ps.0000000451

CiNii Research

Language：English  

DOI： 10.1007/s00595-022-02611-7

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PubMed

Language：English  

DOI： 10.1007/s00383-023-05461-7

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Language：English  

DOI： 10.1002/jhbp.1235

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Language：English  

DOI： 10.1111/ases.13133

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DOI： 10.1111/ases.13139

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DOI： 10.1007/s00595-023-02652-6

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DOI： 10.1089/lap.2022.0390

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Language：English  

DOI： 10.1016/j.arcped.2022.11.016

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PubMed

Language：English  

DOI： 10.1186/s40792-023-01586-y

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Language：English  

DOI： 10.3389/fped.2022.1090336

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PubMed

Language：English  

DOI： 10.1111/ped.15454

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PubMed

Language：English  

DOI： 10.1111/ases.13116

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PubMed

Language：English  

DOI： 10.1111/ases.13119

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PubMed

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.46.0_52

CiNii Research

Language：Japanese   Publisher：The Association of Japanese Geographers  

DOI： 10.14866/ajg.2023s.0_179

CiNii Research

Language：English  

DOI： 10.3389/fped.2022.1053154

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PubMed

Language：English  

DOI： 10.1186/s12894-022-01153-x

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PubMed

Language：English  

DOI： 10.1007/s00383-022-05235-7

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Language：English  

DOI： 10.1007/s00383-022-05230-y

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PubMed

Language：English  

DOI： 10.1007/s00383-022-05243-7

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PubMed

Language：English  

DOI： 10.1186/s12887-022-03755-8

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PubMed

Language：English  

DOI： 10.3389/fped.2022.1030934

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PubMed

Language：English  

DOI： 10.3389/fped.2022.1005879

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PubMed

Language：English  

DOI： 10.18999/nagjms.84.4.716

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PubMed

Publisher：東京医学社  

DOI： 10.24479/ps.0000000254

CiNii Research

Language：English  

DOI： 10.1007/s00464-022-09132-x

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PubMed

Publisher：東京医学社  

DOI： 10.24479/ps.0000000238

CiNii Research

Publisher：東京医学社  

DOI： 10.24479/ps.0000000234

CiNii Research

Language：English  

DOI： 10.1007/s00464-022-09185-y

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PubMed

Language：English  

DOI： 10.1186/s12893-022-01738-1

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PubMed

Language：English  

DOI： 10.4103/jmas.JMAS_98_21

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Language：English   Publisher：Surgical Endoscopy  

Background: Most studies reporting the outcomes of laparoscopic ovarian prolapsed hernia operations with large sample sizes are based on intracorporeal closure, while studies on extraperitoneal closure have limited sample sizes. We proactively used the single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) technique and obtained favorable outcomes, which we report in this paper. Methods: We retrospectively reviewed patients who had undergone laparoscopic surgery for inguinal hernia at our institution. They were retrospectively classified into two groups based on the pre- or intraoperative diagnosis of hernia with a prolapsed ovary, namely the prolapse group and the non-prolapse group, respectively. The data were statistically analyzed and p < 0.05 was considered statistically significant. Results: A total of 771 subjects underwent SILPEC during the study period, including 400 girls. Among them, 63 girls were diagnosed with an ovarian prolapsed hernia. SILPEC was successfully performed through a single port in all cases, with a single exception, in whom the forceps was inserted directly through the right lower quadrant to pull up the ovary. The duration of surgery in the prolapse group was not higher than that in the non-prolapse group. During the SILPEC surgery, the ovaries were successfully reverted into the abdominal cavity by external compression of the inguinal area alone in 38 of the 63 patients. In the remaining 25 cases, the ovaries were reverted into the abdominal cavity by external compression of the inguinal area and traction of the round ligament with forceps. None of these cases failed to return to the ovaries. Conclusion: Our study results indicate that SILPEC may be performed safely for the treatment of ovarian prolapsed inguinal hernia. Since the ovary and fallopian tube are close to the internal inguinal ring due to the short round ligament, the procedure requires careful suturing with traction of the round ligament.

DOI： 10.1007/s00464-021-08777-4

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Scopus

PubMed

Language：English  

DOI： 10.1007/s00383-022-05125-y

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PubMed

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Language：English  

DOI： 10.1186/s12887-022-03207-3

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PubMed

Language：English  

DOI： 10.18999/nagjms.84.1.148

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PubMed

Language：English  

DOI： 10.4240/wjgs.v14.i1.56

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PubMed

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.45.0_77

CiNii Research

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.45.0_74

CiNii Research

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2022081278

CiNii Research

Language：English   Publisher：Pediatric Surgery International  

Purpose: Minimally invasive examinations are particularly important in pediatric patients. Although the significance of urinary N1,N12-diacetylspermine (DiAcSpm) as a tumor marker (TM) has been reported in many types of adult cancers, its usefulness in pediatric cancers has not been reported. This may be due to urinary DiAcSpm level variations with age. This study aims to measure the normal levels of urinary DiAcSpm in healthy individuals and investigate its usefulness as a TM in childhood cancer. Methods: Urinary samples were collected from pediatric patients with and without cancer. The urinary DiAcSpm levels were measured, and the values were compared. Results: A total of 32 patients with cancer and 405 controls were enrolled in the study. Of the 32 patients, 13 had neuroblastoma, 9 had malignant lymphoma (ML), and 10 had leukemia. In the control group, the urinary DiAcSpm values markedly fluctuated among those with young age, especially infants; meanwhile, the values converged among those aged roughly 10 years and above. The sensitivity of DiAcSpm was significantly different among the three types of cancers: neuroblastoma (30.8%), ML (77.8%), and leukemia (40%). Conclusion: The urinary DiAcSpm value is a useful TM for both screening and follow-up of ML.

DOI： 10.1007/s00383-021-04987-y

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Language：English   Publisher：Pediatric Surgery International  

Purpose: The features of right-sided congenital diaphragmatic hernias (RCDHs) are quite different from those of left-sided CDHs (LCDHs). We have summarized the features of RCDHs experienced in our institution. Methods: This retrospective study analyzed the cases of patients with CDH registered at our institution between 2011 and 2020. Defects on each side were compared based on prenatal diagnosis, medical treatment, type of surgery, and outcomes. Results: A total of 101 patients underwent surgery at our institution during the neonatal period, and 11 had RCDHs. RCDHs and LCDHs were significantly different in terms of extracorporeal membrane oxygenation (36% vs. 6%, p = 0.002), patch repair (81% vs. 28%, p < 0.001), recurrence rate (36% vs. 11%, p = 0.022), and length of hospital stay (117 days vs. 51 days, p = 0.012). The severity of the fetal diagnosis did not reflect postnatal severity. All patients with RCDH survived to discharge, and there was no significant difference in survival rate between the right and left sides. Conclusion: Neonates with RCDH required more intensive treatments; however, the survival rate was comparable between RCDH and LCDH. RCDH was significantly different from LCDH and an optimal treatment strategy for RCDHs should be established.

DOI： 10.1007/s00383-021-04999-8

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PubMed

Language：English   Publisher：Pediatric Surgery International  

Purpose: Tracheomalacia (TM) is a frequent complication after esophageal atresia (EA) repair. This study aimed to review patients who underwent aortopexy for TM after EA repair and to compare their imaging features. Methods: The patients who underwent thoracoscopic EA repair and contrast-enhanced computed tomography (CECT) at our hospital between 2013 and 2020 were retrospectively reviewed. The ratio of the lateral and anterior–posterior diameter of the trachea (LAR) where the brachiocephalic artery (BCA) crosses the trachea was defined. The LAR of the patients who underwent CECT for asymptomatic pulmonary disease was set as a normal reference. The Z-score of each LAR was calculated and compared between the patients that did or did not undergo aortopexy. Results: A total of 51 patients represented the controls, 5 patients underwent aortopexy, and 12 patients were discharged without surgery. The mean LARs in the patients who underwent aortopexy, did not undergo aortopexy, and controls were 3.54, 1.54, and 1.15, respectively. The mean Z-score of the aortopexy group was 21.2. After successful aortopexy, each patient’s LAR decreased to < 1.5. Conclusion: Aortopexy was preferred if the trachea was compressed by the BCA. The LAR is a useful indicator for predicting the therapeutic effect of aortopexy.

DOI： 10.1007/s00383-021-04985-0

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PubMed

Language：English  

DOI： 10.18999/nagjms.83.4.765

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PubMed

Language：English   Publisher：Pediatrics International  

Background: Endoscopic variceal ligation (EVL) is a widely accepted treatment for esophagogastric varices in patients with portal hypertension (PHT). It is used for urgent treatment and prophylactic treatment of esophagogastric varices in pediatric as well as adult patients. However, major life-threatening adverse events such as early rebleeding can occur. Although early rebleeding after EVL among children and adolescents has been reported, the risk factors remain obscure. This study evaluated the risk factors for early rebleeding after EVL in children and adolescents. Methods: The subjects were children and adolescents (<18 years) with PHT who underwent EVL for esophagogastric varices. Early rebleeding was defined as hematemesis, active bleeding, or blood retention in the stomach, confirmed by esophagogastroduodenoscopy from 2 h to 5 days after EVL. Results: A total of 50 EVL sessions on 22 patients were eligible for this study. There were four episodes of early rebleeding. No other major adverse event has occurred. Multivariate analysis showed that EVL implemented at cardiac varices just below the esophagogastric junction (EGJ), within 5 mm from the EGJ, is the independent factor for a higher risk of early rebleeding: odds ratio 18.2 (95% confidence interval: 1.40–237.0), P = 0.02. Conclusions: Children and adolescents who undergo EVL for cardiac varices just below the EGJ have a higher risk of early rebleeding than those who do not.

DOI： 10.1111/ped.14614

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PubMed

Language：English   Publisher：Surgery Today  

Purpose: To investigate late complications after surgery for congenital biliary dilatation (CBD). Methods: We retrospectively reviewed the patients treated for late postoperative complications of extrahepatic bile duct resection with bilioenteric anastomosis for CBD at our hospital between 1999 and 2019. Results: Twenty-seven complications, including bile duct stenosis with (n = 19) or without (n = 3) hepatolithiasis, remnant intrapancreatic bile duct (n = 2), intestinal obstruction (n = 2), and refractory cholangitis (n = 1) were treated in 26 patients. The median age at radical surgery and the initial treatment of complications was 3 years, 2 months and 14 years, 5 months, respectively. The median period from radical surgery to initial treatment of complications was 7 years, 1 month. Before 2013, bile duct stenosis was initially treated with bile duct plasty (n = 11) or hepatectomy (n = 3), and 71.4% (n = 10) of patients needed further treatment; after 2013, double-balloon endoscopic retrograde cholangiography (DBERC) was used (n = 8), and 25% (n = 2) of patients needed further treatment. Patients with remnant intrapancreatic bile duct, intestinal obstruction, and refractory cholangitis required surgery. Conclusion: Long-term follow-up is necessary after surgery for congenital biliary dilatation. DBERC is thus considered to be useful for bile duct stenosis management.

DOI： 10.1007/s00595-021-02238-0

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Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p>A 13-year-old girl who presented with left lower abdominal pain was referred to our hospital. Enhanced abdominal CT revealed a 130 mm tumor in the pelvis invading the left ureter and the left iliac artery and vein. We performed laparoscopic-assisted biopsy, and on the basis of biopsy findings, we diagnosed the patient as having rhabdomyosarcoma. We performed radical resection because we confirmed that the tumor had shrank after chemoradiotherapy. We resected the tumor together with the left ureter and the left iliac artery and vein, and we reconstructed the left common iliac artery using an artificial graft and anastomosed the left ureter to the right ureter (transureteroureterostomy). The patient was administered surgical adjuvant chemotherapy, and she is now healthy at 3 years and 3 months after the surgery with no sign of recurrence. We experienced treating a case of retroperitoneal primary rhabdomyosarcoma invading the left ureter and left iliac artery and vein with a good prognosis by multidisciplinary treatment. The cooperation with specialists of each department seems to provide a safe and useful treatment, even for rhabdomyosarcoma requiring the resection of a combination of major blood vessels and ureters.</p>

DOI： 10.11164/jjsps.57.5_878

CiNii Research

Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p>A 21-month-old girl with chief complaints of vomiting and fever was admitted to a hospital and diagnosed as having congenital biliary dilatation. Magnetic resonance imaging performed on the sixth day of hospitalization revealed bile duct perforation, and the patient was transferred to our department for further treatment. A perforation approximately 2 cm in diameter was found at the confluence of the common bile duct and cystic duct. We concluded that biliary drainage and repair of the perforation would not improve her pathophysiology. Therefore, laparoscopic one-stage radical surgery was performed. In addition, bile duct plasty was performed to treat the severe intrahepatic bile duct membranous stenosis that were observed in the right and left bile ducts of the hepatic hilum. The patient was discharged without complications on the tenth postoperative day.</p><p>Two-stage surgery is the recommended treatment method for congenital biliary dilatation with biliary perforation. However, in recent years, there have been few reports showing that one-stage open radical surgery is useful. In this case, we successfully performed laparoscopic one-stage radical surgery for congenital biliary dilatation with biliary perforation. If laparoscopic radical surgery for congenital biliary dilatation is established at the institution, and the patient is in good general condition, laparoscopic one-stage radical surgery may be an effective modality for treating this condition.</p>

DOI： 10.11164/jjsps.57.5_855

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Language：Japanese  

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Language：English   Publisher：Pediatric Surgery International  

A correction to this paper has been published: https://doi.org/10.1007/s00383-021-04873-7.

DOI： 10.1007/s00383-021-04873-7

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Language：Japanese  

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Language：English   Publisher：Scientific Reports  

Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. Bile duct and anastomotic strictures and intrahepatic stones are common postoperative complications of congenital biliary dilatation (CBD). We performed double-balloon endoscopic retrograde cholangiography (DBERC) for diagnostic and therapeutic purposes after radical surgery. We focused on the effectiveness of DBERC for the treatment of postoperative complications of CBD patients. This retrospective study included 28 patients who underwent DBERC (44 procedures) after radical surgery for CBD between January 2011 and December 2019. Strictures were diagnosed as “bile duct strictures” if endoscopy confirmed the presence of bile duct mucosa between the stenotic and anastomotic regions, and as “anastomotic strictures” if the mucosa was absent. The median patient age was 4 (range 0–67) years at the time of primary surgery for CBD and 27.5 (range 8–76) years at the time of DBERC. All anastomotic strictures could be treated with only by 1–2 courses of balloon dilatation of DBERC, while many bile duct strictures (41.2%) needed ≥ 3 treatments, especially those who underwent operative bile duct plasty as the first treatment (83.3%). Although the study was limited by the short follow-up period after DBERC treatment, DBERC is recommended as the first-line treatment for hepatolithiasis associated with biliary and anastomotic strictures in CBD patients, and it can be safely performed multiple times.

DOI： 10.1038/s41598-021-90550-7

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PubMed

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021229976

CiNii Research

Language：Japanese  

DOI： 10.1200/JCO.2021.39.15_suppl.e22008

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Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p><i>Purpose</i>: The treatment outcomes of patients with laparoscopic surgery for biliary atresia (laparoscopic portoenterostomy) were retrospectively evaluated to determine whether to limit the laparoscopic surgery for biliary atresia to fully experienced surgeons.</p><p><i>Methods</i>: We included 37 patients with laparoscopic portoenterostomy for biliary atresia at our institution from 2014 to 2018. Twelve patients were treated by a surgeon fully experienced in laparoscopic portoenterostomy (Group A) and 23 patients were treated by other surgeons (Group B). Jaundice reduction and jaundice-free survival of patients with the native liver in the two groups were compared.</p><p><i>Results</i>: Differences in age at the time of surgery, body weight, perioperative blood loss, time of drain removal, and time that milk or formula feeding resumed in both groups were not significant. The duration of surgery was significantly shorter in Group A than in Group B. The jaundice-free survival rates of patients with the native liver were 58.3% in Group A and 60.9% in Group B at 6 months after surgery, 66.7% in Group A and 65.2% in Group B at 1 year after surgery, and 58.3% in Group A and 56.5% in Group B at 2 years after surgery. No significant difference was observed.</p><p><i>Conclusions</i>: In this study, no significant difference in the rate of jaundice-free survival of patients with the native liver depending on the amount of surgical experience was observed under the guidance of an operator who was skilled in laparoscopic portoenterostomy.</p>

DOI： 10.11164/jjsps.57.3_596

CiNii Research

Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p>The patient was a newborn female with colonic atresia and gastroschisis. A silo was placed immediately after birth and surgery was scheduled the following day. Adhesive detachment was performed by washing the intestinal tract with saline. The oral and anal segments of the colonic atresia were identified, and functional end-to-end anastomosis was performed. Severe edema precluded the immediate return of the intestines to the abdominal cavity and required ongoing treatment with a silo. The intestines gradually returned to the abdominal cavity during the following week. The abdominal wall was closed on postnatal day 9 by a sutureless method. The patient’s postoperative course was good, and full feeding was initiated on postnatal day 19. The patient was discharged from the hospital on postnatal day 32 and recovered without complications. In cases of gastroschisis with colonic atresia, a two-stage surgical procedure is commonly employed. However, functional end-to-end anastomosis using a linear stapler is also an effective method because anastomoses can be performed without regard to differences in intestinal caliber.</p>

DOI： 10.11164/jjsps.57.1_22

CiNii Research

Language：English   Publisher：Scientific Reports  

Urine is a complex liquid containing numerous small molecular metabolites. The ability to non-invasively test for cancer biomarkers in urine is especially beneficial for screening child patients. This study attempted to identify neuroblastoma biomarkers by comprehensively analysing urinary metabolite samples from children. A total of 87 urine samples were collected from 54 participants (15 children with neuroblastoma and 39 without cancer) and used to perform a comprehensive analysis. Urine metabolites were extracted using liquid chromatography/mass spectrometry and analysed by Metabolon, Inc. Biomarker candidates were extracted using the Wilcoxon rank sum test, random forest method (RF), and orthogonal partial least squares discriminant analysis (OPLS-DA). RF identified three important metabolic pathways in 15 samples from children with neuroblastoma. One metabolite was selected from each of the three identified pathways and combined to create a biomarker candidate (3-MTS, CTN, and COR) that represented each of the three pathways; using this candidate, all 15 cases were accurately distinguishable from the control group. Two cases in which known biomarkers were negative tested positive using this new biomarker. Furthermore, the predictive value did not decrease in cases with a low therapeutic effect. This approach could be effectively applied to identify biomarkers for other cancer types.

DOI： 10.1038/s41598-021-83619-w

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Language：English   Publisher：Pediatric Surgery International  

Purpose: This study aimed to investigate the negative effects of intestinal obstruction for jaundice-free native liver survival after Kasai portoenterostomy (PE) for biliary atresia (BA). Methods: We retrospectively reviewed the records of patients who underwent PE for BA between 2006 and 2019. We evaluated the postoperative morbidity of intestinal obstruction for up to 2 years after PE and the effects of intestinal obstruction on jaundice-free native liver survival. On the basis of their initial operation, patients were divided into open portoenterostomy (Open-PE) and laparoscopic portoenterostomy (Lap-PE) groups, and morbidity was compared. Results: Of the 87 patients reviewed, 6 (6.9%) patients developed postoperative intestinal obstruction and underwent surgery to relieve the obstruction. The morbidity of early postoperative intestinal obstruction was 1.68 per 10,000 person days. The jaundice-free native liver survival rate among patients who once achieved jaundice-free status after PE was significantly lower in the patients with intestinal obstruction compared to in those without intestinal obstruction (0% vs. 73.8%; RR = 3.81, p = 0.007). No significant differences were seen in postoperative intestinal obstructions between the Open-PE and Lap-PE groups (p = 0.242). Conclusions: Intestinal obstruction negatively impact jaundice-free native liver survival, even in patients who once achieved jaundice-free status after PE for BA.

DOI： 10.1007/s00383-020-04807-9

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Language：English   Publisher：Pediatric Surgery International  

Purpose: Although we generally perform thoracoscopic lobectomy for congenital lung cysts (CLCs), we recently began performing thoracoscopic-limited pulmonary resection (segmentectomy or small partial lung resection) on relatively small lesions and on lesions involving multiple lobes. Our study aimed to determine the therapeutic outcomes of thoracoscopic CLC surgery. Methods: We retrospectively reviewed patients aged ≤ 18 years who underwent their first CLC surgery at our facility between 2013 and 2020. Results: A comparison between patients < 4 months old and those ≥ 4 months old showed no significant difference in operating time or incidence of complications. Blood loss volume (mL/kg) was significantly greater in patients < 4 months old and in patients who had undergone semi-urgent or urgent surgery. Operating time and postoperative complications were not increased in semi-urgent or urgent surgeries. There was no significant difference in operating time, blood loss volume, or postoperative complications between patients with a preoperative history of pneumonia and patients with no such history. Conclusion: In most patients, thoracoscopic surgery for CLC was safely performed. Limited pulmonary resection is considered difficult to perform thoracoscopically in children, but can be safely performed using new devices and navigation methods. Level of evidence: III.

DOI： 10.1007/s00383-020-04793-y

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Language：English   Publisher：Pediatric Surgery International  

Purpose: One of the main causes of stricture at hepaticojejunostomy site after surgery for congenital biliary dilatation is inflammation or infection associated with bile leak. The aim of this study was to determine the risk factors and outcomes of bile leak after laparoscopic surgery. Methods: We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic surgery for congenital biliary dilatation between September 2013 and December 2019. Data from patients with bile leak were compared to data from patients without bile leak. Results: Fourteen of 78 patients had bile leak. Hepatic duct diameter at anastomosis was the only risk factor of bile leak. Patients with the diameter ≤ 10 mm had higher incidence of bile leak than in patients with the diameter > 10 mm (P = 0.0023). Among them, bile leak occurred more frequently in patients operated on by non-qualified surgeons based on the Japan Society for Endoscopic Surgery endoscopic surgical skill qualification system than by qualified surgeons (P = 0.027). However, none of the patients with bile leak developed anastomotic stricture afterwards. Conclusion: Although good technical skill is necessary to avoid bile leak in narrow hepatic duct cases (≤ 10 mm), slight bile leak may not result in anastomotic stricture.

DOI： 10.1007/s00383-020-04791-0

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PubMed

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.44.0_50

CiNii Research

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.44.0_72

CiNii Research

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021085587

CiNii Research

Language：English   Publisher：BMC Surgery  

Background: In cases of Hirschsprung disease, complete and reproducible resection of the aganglionic bowel is ideal to achieve good postoperative bowel function. Reliable identification of the upper margin of the surgical anal canal, which is the squamous-columnar junction, is necessary during transanal pull-through. Here, we describe a novel staining technique using Lugol’s iodine stain to visualize the upper margin of the surgical anal canal. Methods: Lugol’s iodine staining was performed in five patients with Hirschsprung disease treated using a single-stage laparoscopic transanal pull-through modified Swenson procedure. In two of these patients, endocytoscopic observation with ultra-high magnification was performed using methylene blue and crystal violet to mark the border of the squamous epithelium at 1 week before surgery. The alignment between the incisional line, which was revealed using Lugol’s iodine staining and endocytoscopic marking, was evaluated. Complications, including postoperative bowel dysfunction, were evaluated. Results: In all cases, Lugol’s iodine staining produced a well-demarcated line. The endocytoscopic marking of the upper margin of the surgical anal canal was aligned with the line revealed by Lugol’s iodine staining. There were no complications associated with the transanal pull-through procedure, including postoperative bowel dysfunction. Conclusions: Lugol’s iodine staining could be a safe and practical method to visualize the upper margin of the surgical anal canal intraoperatively. This finding may be useful for surgeons to make a consistent removal of the aganglionic bowel during surgery for Hirschsprung disease.

DOI： 10.1186/s12893-020-00986-3

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PubMed

Language：English   Publisher：Surgical Endoscopy  

Background: Native liver survival after laparoscopic Kasai portoenterostomy (Lap-PE) for biliary atresia (BA) is controversial. We examined whether a jaundice-free native liver survival rate is comparable between conventional Kasai portoenterostomy (Open-PE) and Lap-PE. Then, the impact of the two types of PE on subsequent living-donor liver transplantation (LTx) was addressed in this study. Methods: The jaundice-free rate in 1- and 2-year-old patients who underwent Open-PE and Lap-PE from January 2006 to December 2017 was investigated. Additionally, perioperative data (duration from the start of surgery to the completion of hepatectomy and others) of patients aged 2 years or younger who underwent LTx after either Open-PE or Lap-PE from 2006 to 2017 were evaluated. Results: Thirty-one (67%) out of 46 Open-PE patients and 23 (77%) out of 30 Lap-PE patients showed native liver survival with jaundice-free status at 1 year of age (p = 0.384); 29 (63%) out of 46 Open-PE patients and 19 (70%) out of 27 Lap-PE patients showed native liver survival with jaundice-free status at 2 years of age (p = 0.524); there were no significant differences. Additionally, there were 37 LTx cases after PE within 2 years of birth, including 29 Open-PE and 8 Lap-PE cases. The patients in the Lap-PE group had fewer adhesions and significantly shorter durations of surgery up to the completion of the recipient’s hepatectomy and durations of post-LTx hospital stay compared to the Open-PE group. There were no differences in blood loss or duration of stay in intensive care unit between the Lap-PE and Open-PE groups. Conclusions: Jaundice-free native liver survival rate has been comparable between Open-PE and Lap-PE. Lap-PE resulted in fewer adhesions, contributing to better outcomes of subsequent LTx compared to Open-PE.

DOI： 10.1007/s00464-019-07108-y

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PubMed

Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p>A 6-year-old boy who presented with abdominal pain was referred to our hospital. Enhanced abdominal CT revealed free gases in the abdominal cavity. We diagnosed him as having acute peritonitis owing to gastrointestinal perforation, but we were unable to identify the perforation site preoperatively. We performed emergency single-port laparoscopic-assisted surgery using a multichannel port (two 5-mm ports) with umbilical Benz incision. We identified the inflammatory ileum and pulled it out. A cystic lesion, with a hole at the base, was detected about 40 cm proximal to the end of the ileum. We partially resected the ileum. A histopathological examination revealed perforation of ileac duplication, which is rare and its preoperative diagnosis is difficult. We performed the single-port laparoscopic-assisted surgery without wound extension. The single-port laparoscopic-assisted surgery with the Benz incision is useful for the diagnosis and treatment of pediatric acute abdomen.</p>

DOI： 10.11164/jjsps.56.3_330

CiNii Research

Language：English   Publisher：BMC Pediatrics  

Background: The fundamental treatment for patients with pediatric malignant mediastinal tumors is chemotherapy. Therefore, accurate diagnosis is essential for selecting the appropriate chemotherapeutic regimen. However, malignant mediastinal tumors occasionally cause respiratory distress, and biopsies under general anesthesia are dangerous for such patients as invasive mechanical ventilation can aggravate airway obstruction caused by mass effect. In this study, we reviewed our 10-year diagnostic experience to evaluate the efficacy of our practices and confirm a safe diagnostic protocol for future patients. Methods: We retrospectively reviewed medical records of children with malignant mediastinal tumors diagnosed at Nagoya University Hospital from 2007 to 2018 who demonstrated respiratory distress. Respiratory distress included dyspnea, massive pleural effusion, wheezing, and hypoxemia owing to tumors. Data on sex, age at onset, primary symptoms, location of tumor, management strategy (especially the method of diagnosis and definitive diagnosis), clinical course, prognosis during the acute phase (within 3 months from the onset of respiratory symptoms), and long-term outcome were collected. Results: Twelve pediatric patients met the review criteria. There were seven anterior mediastinal tumors and five posterior mediastinal tumors. All anterior mediastinal tumors were diagnosed via bone marrow smear, thoracentesis, or core needle biopsy while maintaining spontaneous breathing. Regarding posterior tumors, two patients were diagnosed via a core needle biopsy and lymph node excisional biopsy under spontaneous breathing. Two cases were initially diagnosed solely using tumor markers. One patient with severe tracheal compression underwent tumor resection with extracorporeal membrane oxygenation stand-by. No patient died of diagnostic procedure-related complications. Conclusions: In 11 of the 12 cases reviewed, safe and accurate tumor diagnosis was accomplished without general anesthesia. A diagnostic strategy without general anesthesia considering the tumor location proved to be useful.

DOI： 10.1186/s12887-020-02183-w

Web of Science

Scopus

PubMed

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2020230886

CiNii Research

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.43.0_84

CiNii Research

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.43.0_36

CiNii Research

Language：Japanese  

Web of Science

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2020041175

CiNii Research

Language：English   Publisher：Pediatric Surgery International  

Purpose: High-dose postoperative steroid therapy after Kasai portoenterostomy is reported to improve jaundice clearance and a strong anti-inflammatory activity might prevent fibrous tissue formation which is often observed at the porta hepatis in revision surgery. We started steroid pulse therapy for the patients with cessation of decrease in jaundice and aimed to evaluate the efficacy in this study. Methods: The demographics and outcomes of patients who underwent laparoscopic Kasai portoenterostomy and received steroid pulse therapy within 2 months postoperatively between September 2014 and December 2018 were retrospectively reviewed; the therapy was determined successful when the serum total bilirubin level decreased to or below two-thirds of the pre-therapy level after 2 weeks. Patient data in the successful group were compared with those in the unsuccessful group. Results: Steroid pulse therapy was successful in seven of 16 patients (43.8%). The percentage of patients whose serum total bilirubin level decreased to normal was significantly higher in the successful group at 3 months (85.7% vs. 11.1%, P = 0.0028) and after all (100% vs. 33.3%, P = 0.011). Conclusions: Steroid pulse therapy was effective for some patients. Unsuccessful cases may have little chances of jaundice clearance; revision Kasai portoenterostomy would be a good option.

DOI： 10.1007/s00383-019-04537-7

Web of Science

Scopus

PubMed

Language：English   Publisher：Pediatric Surgery International  

Purpose: Thoracoscopic repair can be safely performed in most types of congenital esophageal atresia (EA), including in patients with long gap EA or very low birth weight. Accordingly, we performed single- or multistage thoracoscopic repair for various EA types. We aimed to report our therapeutic strategy for thoracoscopic radical surgery for treating EA and its outcome. Methods: Outcomes of radical surgeries for treating congenital EA at our institute from 2013 to 2018 were retrospectively evaluated. Results: Thirty-eight radical surgeries were evaluated: 3 Gross type-A, 1 type-B, 30 type-C, 1 type-D, and 3 type-E. The cervical approach was performed in 5 cases and thoracoscopic esophageal anastomosis in 33, including 26 single-stage (all type-C) and 7 multistage surgeries (3 type-A, 3 type-C, and 1 type-D). There were no cases of thoracotomies or intraoperative thoracoscopic surgery complications. Three cases of minor leakage were conservatively resolved. Three postoperative chylothorax surgeries (9%) and seven balloon dilatations (21%) for anastomotic stenosis were performed. Conclusion: Thoracoscopic radical surgery for treating EA, including single- and multistage procedures, can be performed, except in type-E cases or when the end of the proximal esophagus is located higher than the clavicle.

DOI： 10.1007/s00383-019-04541-x

Web of Science

Scopus

PubMed

Language：English   Publisher：Pediatric Surgery International  

Purpose: Anovestibular fistula (AVF) is the most common type of anorectal malformation in females. Delayed anorectoplasty with fistula dilatation is commonly performed during infancy; however, we have been actively performing anorectoplasty in neonates. We report the surgical complications and postoperative defecation function associated with single-stage anorectoplasty performed in neonates. Methods: Patients who underwent surgery for AVF between 2007 and 2017 at two institutions were retrospectively studied. The operation time, amount of bleeding, time to start oral intake, perioperative complications, and Kelly’s score were compared among patients who underwent surgery as neonates and those who underwent surgery as infants. Results: Eighteen neonates and 17 infants underwent anterior sagittal anorectoplasty. The median operation time and time to start oral intake were significantly shorter in the neonatal group (72 min; 3 days, respectively) than in the infant group (110 min, p = 0.0002; 5 days, p = 0.0024, respectively). Postoperative wound disruption was significantly more frequent in the infant group. Of the ten patients each in the neonatal and infant groups, there was no significant difference in Kelly’s score at age ≥ 4 years. Conclusion: Single-stage anorectoplasty in neonates with AVF can be feasibly performed and does not impair postoperative defecation function. Levels of evidence: III.

DOI： 10.1007/s00383-018-4324-3

Web of Science

Scopus

PubMed

Language：English   Publisher：Pediatric Surgery International  

Purpose: Laparoscopic-assisted anorectoplasty (LAARP) is a minimally invasive procedure in which the levator ani muscle is left to potentially improve postoperative fecal continence. This study aimed to retrospectively evaluate postoperative complications and long-term outcomes of fecal continence after LAARP and compare them to those after posterior sagittal anorectoplasty (PSARP). Methods: Forty-five male patients with high and intermediate anorectal malformation (aged ≥ 4 years) who underwent LAARP or PSARP (LAARP 29, PSARP 16) from 1999 to 2013 were included. Postoperative complications and postoperative fecal continence were retrospectively evaluated and compared. Postoperative complications were also compared before and after introducing a urethroscope during fistula resection. Results: Complications after LAARP and PSARP were seen in 12 vs. 2 cases (p = 0.09) of mucosal prolapse and in 9 vs. 1 case (p = 0.07) of posterior urethral diverticulum (PUD), respectively. The incidence of PUD decreased after introduction of a urethroscopy from 40% in 8/20 cases to 11% in 1/9 cases. No significant difference was found in terms of fecal continence in both groups. Conclusion: Through our study, greater improvement of postoperative fecal continence after LAARP has not been shown. LAARP was at higher risk for mucosal prolapse and PUD. However, precise dissection of the urethral fistula could be performed after the introduction of urethroscopy.

DOI： 10.1007/s00383-018-4323-4

Web of Science

Scopus

PubMed

Language：English   Publisher：Surgery Today  

Purpose: We aimed to identify the risk factors for thoracic and spinal deformities following lung resection during childhood and to elucidate whether thoracoscopic surgery reduces the risk of complications after lung resection. Methods: We retrospectively examined the medical records of all pediatric patients who underwent lung resection for congenital lung disease at our institution between 1989 and 2014. Results: Seventy-four patients underwent lung resection during the study period and were followed-up. The median age of the patients at the time of surgery was 5 months (range 1 day–13 years), and 22 were neonates. Thoracotomy and thoracoscopy were performed in 25 and 49 patients, respectively. Thoracic or spinal deformities occurred in 28 of the 74 patients (37%). Univariate analyses identified thoracotomy, being a neonate (age: <1 month) at the time of surgery, and being symptomatic at the time of surgery as risk factors for these deformities. However, a multivariate analysis indicated that only thoracotomy and being a neonate were risk factors for deformities. Conclusions: Thoracoscopic surgery reduced the risk of thoracic and spinal deformities following lung resection in children. We suggest that, where possible, lung resection should be avoided until 2 or 3 months of age.

DOI： 10.1007/s00595-016-1434-1

Web of Science

Scopus

PubMed