Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study evaluated portal hypertension (PHT) and its predictors among native liver survivors (NLS) of biliary atresia (BA) after Kasai portoenterostomy (KPE). METHODS: This was a multicenter study using prospectively collected data. The subjects were patients who remained transplant-free for 5 years after KPE. Their status of PHT was evaluated and variables that predicted PHT were determined by regression analysis and receiver operating characteristic (ROC) curve. RESULTS: Six centers from East Asia participated in this study and 320 subjects with KPE between 1980 to 2018 were analyzed. The mean follow-up period was 10.6 ± 6.2 years. At the 5th year after KPE, PHT was found in 37.8% of the subjects (n = 121). Patients with KPE done before day 41 of life had the lowest percentage of PHT compared to operation at older age. At 12 months after KPE, PHT + ve subjects had a higher bilirubin level (27.1 ± 11.7 vs 12.3 ± 7.9 µmol/L, p = 0.000) and persistent jaundice conferred a higher risk for PHT (OR = 12.9 [9.2-15.4], p = 0.000). ROC analysis demonstrated that a bilirubin level above 38 µmol/L at 12 months after KPE predicted PHT development (sensitivity: 78%, specificity: 60%, AUROC: 0.75). CONCLUSIONS: In BA, early KPE protects against the development of PHT among NLSs. Patients with persistent cholestasis at one year after KPE are at a higher risk of this complication. They should receive a more vigilant follow-up. LEVEL OF EVIDENCE: Level III.

DOI： 10.1007/s00383-024-05775-0

PubMed

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The prognostic factors of subsequent liver transplantation (LT) in patients with biliary atresia (BA) who presented with jaundice-free native liver survival were investigated. METHODS: This study retrospectively reviewed patients who underwent portoenterostomy (PE) for BA. Patients with jaundice-free native liver survival at 1 year postoperatively were divided into the autologous liver survivor and liver transplant recipient groups. Peri- and postoperative data were compared between the two groups. RESULTS: Among 97 patients with BA, 29 who received LT within 1 year after PE were excluded from the analysis. Further, 48 patients currently living with native liver and 20 who received LT after 1 year postoperatively were compared. Bile lake (BL) was the strongest risk factor of LT. The risk score was 2.38 ∗ B L s c o r e + 0.00466 ∗ T B A , and the area under the receiver operating characteristic curve was 0.83. Patients with BL and those without significantly differed in terms of the native liver survival rate. Patients with BL who presented with not only cholangitis but also gastrointestinal hemorrhage and hepatopulmonary syndrome received LT. CONCLUSION: BL can cause different pathologies. Moreover, it is an evident risk factor of subsequent LT in patients with BA who are living with native liver at 1 year after PE.

DOI： 10.1007/s00383-024-05786-x

PubMed

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.jpedsurg.2024.06.023

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The surgical indication of thoracoscopic primary repair for esophageal atresia with tracheoesophageal fistula is under debate. The current study aimed to investigate the outcome of thoracoscopic primary repair for esophageal atresia with tracheoesophageal fistula in patients weighing < 2000 g and those who underwent emergency surgery at the age of 0 day. METHODS: The surgical outcomes were compared between patients weighing < 2000 g and those weighing > 2000 g at surgery and between patients who underwent surgery at the age of 0 day and those who underwent surgery at age ≥ 1 day. RESULTS: In total, 43 patients underwent thoracoscopic primary repair for esophageal atresia with tracheoesophageal fistula. The surgical outcomes according to body weight were similar. Patients who underwent surgery at the age of 0 day were more likely to develop anastomotic leakage than those who underwent surgery at the age of ≥ 1 day (2 vs. 0 case, p = 0.02). Anastomotic leakage was treated with conservative therapy. CONCLUSION: Thoracoscopic primary repair is safe and useful for esophageal atresia with tracheoesophageal fistula even in newborns weighing < 2000 g. However, emergency surgery at the age of 0 day should be cautiously performed due to the risk of anastomotic leakage.

DOI： 10.1007/s00383-024-05724-x

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s40792-024-01875-0

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-024-05683-3

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpedsurg.2023.10.045

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

The urinary catecholamine metabolites, homovanillic acid (HVA) and vanillylmandelic acid (VMA), are used for the adjunctive diagnosis of neuroblastomas. We aimed to develop a scoring system for the diagnosis and pretreatment risk assessment of neuroblastoma, incorporating age and other urinary catecholamine metabolite combinations. Urine samples from 227 controls (227 samples) and 68 patients with neuroblastoma (228 samples) were evaluated. First, the catecholamine metabolites vanillactic acid (VLA) and 3-methoxytyramine sulfate (MTS) were identified as urinary marker candidates through comprehensive analysis using liquid chromatography-mass spectrometry. The concentrations of these marker candidates and conventional markers were then compared among controls, patients, and numerous risk groups to develop a scoring system. Participants were classified into four groups: control, low risk, intermediate risk, and high risk, and the proportional odds model was fitted using the L2-penalized maximum likelihood method, incorporating age on a monthly scale for adjustment. This scoring model using the novel urine catecholamine metabolite combinations, VLA and MTS, had greater area under the curve values than the model using HVA and VMA for diagnosis (0.978 vs. 0.964), pretreatment risk assessment (low and intermediate risk vs. high risk: 0.866 vs. 0.724; low risk vs. intermediate and high risk: 0.871 vs. 0.680), and prognostic factors (MYCN status: 0.741 vs. 0.369, histology: 0.932 vs. 0.747). The new system also had greater accuracy in detecting missing high-risk neuroblastomas, and in predicting the pretreatment risk at the time of screening. The new scoring system employing VLA and MTS has the potential to replace the conventional adjunctive diagnostic method using HVA and VMA.

DOI： 10.1111/cas.16116

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：東京医学社  

DOI： 10.24479/ps.0000000726

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1089/lap.2023.0220

Web of Science

PubMed

Language：English   Publishing type：Research paper (international conference proceedings)  

The intestine is an essential digestive organ that can cause serious health problems once diseased. This paper proposes a method for intestine segmentation to intestine obstruction diagnosis assistance called multi-dimensional U-Net (M U-Net). We employ two encoders to extract features from two-dimensional (2D) CT slices and three-dimensional (3D) CT patches. These two encoders collaborate to enhance the segmentation accuracy of the model. Additionally, we incorporate deep supervision with the M U-Net to reduce the limitation of training with sparse label data sets. The experimental results demonstrated that the Dice of the proposed method was 73.22%, the recall was 79.89%, and the precision was 70.61%.

DOI： 10.1007/978-3-031-47076-9_14

Web of Science

Scopus

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：一般社団法人 日本周産期・新生児医学会  

<p>　はじめに</p><p>　名古屋大学小児外科では，食道閉鎖症に対して胸腔鏡下根治術を第一選択としている．アメリカでの現状，meta-analysisに触れながら，当院の治療戦略について簡単に述べる．</p>

DOI： 10.34456/jjspnm.59.4_470

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study aimed to evaluate the learning curve of thoracoscopic repair of tracheoesophageal fistula (TEF) by a single surgeon using a cumulative sum (CUSUM) analysis. METHODS: Prospective clinical data of consecutive Gross type-C TEF repairs performed by a pediatric surgeon from 2010 to 2020 were recorded. CUSUM charts for anastomosis and operating times were generated. The learning curves were compared with the effect of accumulation based on case experience. RESULTS: For 33 consecutive cases, the mean operative and anastomosis times were 139 ± 39 min and 3137 ± 1110 s, respectively. Significant transitions beyond the learning phase for total operating and anastomosis times were observed at cases 13 and 17. Both the total operating time and anastomosis time were significantly faster in the proficiency improvement phase than in the initial learning phase. Postoperative complications significantly decreased after the initial anastomosis learning phase but not after the initial total operating learning phase. CONCLUSIONS: Thoracoscopic repair of TEF is considered safe and feasible after 13 cases, where the surgeon can improve their proficiency with the total operation procedure, and 17 cases, which will enable the surgeon to achieve proficiency in anastomosis. Postoperative complications significantly decreased after gaining familiarity with the anastomosis procedure through the learning phase.

DOI： 10.1007/s00595-023-02687-9

Web of Science

PubMed

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12893-023-02232-y

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jhbp.1381

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

AIMS: Biliary atresia (BA) is a congestive biliary disease that develops in the neonatal period or early infancy. It may present with portal hypertension and varices needing treatment (VNT) even after successful Kasai portoenterostomy. This study aimed to stratify the risk of VNT in children and adolescents with BA. METHODS: In this prospective cross-sectional study, we measured liver stiffness (LS) and spleen stiffness (SS) by two-dimensional shear wave elastography and checked for VNT endoscopically in 53 patients with BA who attended for follow-up between July 2018 and September 2022. Varices needing treatment were defined as large esophageal varices, esophageal varices of any size with red color signs, and/or gastric varices along the cardia. RESULTS: Twenty-five patients (aged 0-18 years) had VNT. Eighteen patients met the Baveno VI criteria (LS <20 kPa; platelet count >150 000/L) and were deemed to be at low risk of VNT (spared endoscopies) while three had missed VNT (16.7%). Applying the Baveno VII criteria, which combines the SS cut-off value of 40 kPa with the Baveno VI criteria, resulted in five missed VNTs among 22 spared endoscopies (22.7%). A modification of the Baveno VII criteria using the aspartate aminotransferase-to-platelet ratio index (APRI) instead of the platelet count with cut-off values of 25 kPa, 30 kPa, and 1.04 for LS, SS, and APRI, respectively, missed only one VNT (5.0%) among 20 spared endoscopies. CONCLUSIONS: A novel diagnostic criterion that combines LS, SS, and APRI reduced the risk of missing VNT to 5% in children and adolescents with BA.

DOI： 10.1111/hepr.13976

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00595-023-02757-y

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s40792-023-01754-0

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-023-05550-7

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-023-05548-1

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Congenital chylothorax (CCT) and postoperative chylothorax (POCT) are rare and difficult to treat. We report our treatment strategy and outcomes for chylothorax, including thoracoscopic surgery with indocyanine-green (ICG) near-infrared fluorescence lymphangiography. METHODS: A retrospective review of patients with CCT and POCT from 2014 to 2021 was performed. After definitive diagnosis, conservative treatments with octreotide, followed by intravenous steroids as needed, were performed. Patients who were refractory to conservative treatment were transferred to surgical treatment, consisting of thoracoscopic lymphatic leak ligations using ICG intraoperative lymphangiography. The effectiveness of conservative and surgical treatment was then examined. RESULTS: We included 19 cases of CCT and 31 cases of POCT. The 31 POCT patients included 23 of 84 postoperative patients with congenital diaphragmatic hernia (CDH), 7 of 54 postoperative patients with esophageal atresia (EA), and 1 of 3 postoperative patients with lymphatic malformation. The efficacy of conservative treatment was 12/19 for CCT, 22/23 for CDH, and 4/7 for EA. Surgical intervention was performed in 10 patients, and the rate of resolution of chylothorax within 3 weeks after surgery was 90%. CONCLUSION: Thoracoscopic lymphatic leak ligations with intraoperative ICG lymphangiography are feasible and useful in patients with chylothorax refractory to conservative treatment. LEVEL OF EVIDENCE: Level IV.

DOI： 10.1016/j.jpedsurg.2022.11.018

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00464-023-09975-y

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12887-023-04190-z

Web of Science

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：東京医学社  

DOI： 10.24479/ps.0000000514

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3389/fped.2023.1220393

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3389/fped.2023.1149515

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.12659/AJCR.938723

Web of Science

PubMed

Authorship：Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：東京医学社  

DOI： 10.24479/ps.0000000451

CiNii Research

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：東京医学社  

DOI： 10.24479/ps.0000000439

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Rectal prolapse after radical surgery for anorectal malformations (ARMs) is a common postoperative complication that causes bleeding and stenosis, and sometimes requires surgical treatment. Different surgical techniques have been reported, but most are associated with high recurrence rates and a long postoperative stay. We performed the hemi-circumferential mucosal resection and anastomosis procedure (HCMR) to preserve anal muscle and anal function. Here, we report the success of our minimally invasive surgical approach to correct rectal prolapse in patients with ARMs. METHODS: The subjects of this retrospective review were patients who underwent HCMR for rectal prolapse after radical surgery for ARMs between January, 2014 and August, 2021. HCMR involves rectal mucosal resection without muscle plication. RESULTS: A collective 15 HCMR procedures were performed in 10 patients. The median age at repair was 1.8 years (range, 10 months-18 years). The median operation time and postoperative length of stay were 46 min (range, 17-85 min) and 3 days (range, 1-7 days), respectively. The median postoperative observation period was 3 years 4 months (range, 8 months-7 years 10 months) and no complications or recurrences were observed. CONCLUSIONS: HCMR is a safe and effective surgical treatment for rectal prolapse after radical operation for ARMs, which is minimally invasive and preserves rectal muscle and function.

DOI： 10.1007/s00595-022-02611-7

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Necrotizing enterocolitis (NEC) causes fatal intestinal necrosis in neonates, but its etiology is unknown. We analyzed the intestinal immune response to NEC. METHODS: Using single-cell RNA sequencing (scRNA-seq), we analyzed the gene expression profiles of intestinal immune cells from four neonates with intestinal perforation (two with NEC and two without NEC). Target mononuclear cells were extracted from the lamina propria of the resected intestines. RESULTS: In all four cases, major immune cells, such as T cells (15.1-47.7%), B cells (3.1-19.0%), monocytes (16.5-31.2%), macrophages (1.6-17.4%), dendritic cells (2.4-12.2%), and natural killer cells (7.5-12.8%), were present in similar proportions to those in the neonatal cord blood. Gene set enrichment analysis showed that the MTOR, TNF-α, and MYC signaling pathways were enriched in T cells of the NEC patients, suggesting upregulated immune responses related to inflammation and cell proliferation. In addition, all four cases exhibited a bias toward cell-mediated inflammation, based on the predominance of T helper 1 cells. CONCLUSION: Intestinal immunity in NEC subjects exhibited stronger inflammatory responses compared to non-NEC subjects. Further scRNA-seq and cellular analysis may improve our understanding of the pathogenesis of NEC.

DOI： 10.1007/s00383-023-05461-7

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

We report an extremely rare case of a right Bochdalek hernia with a sac, in which the retroperitoneal and intra-abdominal organs prolapsed into the thoracic cavity at the same time. The patient was a 7-month-old female with no comorbidities. She presented with cough and fever, and chest radiography revealed a right diaphragmatic hernia. Computed tomography showed that the right kidney, intestine, colon, and liver had prolapsed into the thoracic cavity. The patient underwent thoracoscopic surgery, which showed that the abdominal and retroperitoneal organs prolapsed into the thoracic cavity through the Bochdalek hernia. The herniated organs were spontaneously reduced using thoracoscopic insufflation. The defect hole was closed with artificial mesh. We adopted a thoracoscopic approach, in terms of easy reduction of herniated organs and accurate evaluation of the hernia orifice, which was useful.

DOI： 10.1111/ases.13139

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3389/fped.2023.1175231

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00595-023-02652-6

Web of Science

PubMed

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We encountered two cases of a new type of retroperitoneal hernia. We herein report the unique features of these cases. CASE PRESENTATION: Case 1: A Japanese girl was born at a gestational age of 37 weeks, weighing 2550 g. She underwent laparotomic left diaphragmatic hernia repair for a left Bochdalek hernia at the age of one day. The postoperative course was uneventful; however, chest radiography at the age of 35 days revealed bowel gas in the mediastinum, while computed tomography exhibited intestinal prolapses from the medial side of the mesh into the thoracic cavity. Reoperation was performed at the age of 77 days, showing that the defect hole was not at the diaphragm but in the absence of retropancreatic fascia, which was connected to the posterior mediastinum from the supramesocolic space. The mediastinum space was closed with a suturing spine and artificial mesh, and the defect hole in the pancreatic body was sutured. Case 2: A Japanese boy was born at a gestational age of 40 weeks, weighing 3502 g. He was diagnosed with a left diaphragmatic hernia at birth and underwent laparotomy at the age of two days. Operative findings showed no defect hole in the diaphragm, and no intestine was observed in the abdominal cavity. After close observation of the abdominal cavity, the intestine was found around the pancreatic body, and manual reduction of the intestine was performed. The defect hole existed in the absence of the retropancreatic fascia, which was connected to the extra-pleural space. The defect hole in the pancreatic body was sutured and closed with a non-absorbable thread. CONCLUSIONS: We assumed that our cases were a new type of retroperitoneal hernia, which we named "retropancreatic fascia hernia".

DOI： 10.1186/s40792-023-01586-y

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3389/fped.2022.1090336

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

We report a case of hepatolithiasis 30 years after congenital biliary dilatation (CBD) surgery. A 31-year-old woman presented with fever and epigastric pain. She had a history of radical surgery for type I CBD at the age of 1 year and had no significant symptoms for approximately 30 years after surgery. Laboratory and imaging results showed hepatolithiasis at the common trunk of segments II and III with cholangitis. She was admitted to our hospital for antibiotics and underwent double-balloon endoscopic retrograde cholangiography (DBERC) to treat the hepatolithiasis. Roux-limb jejunum was perforated during DBERC; hence, emergent laparoscopic perforation site closure and simultaneous endoscopic lithotomy through the Roux-limb jejunum with exteriorization via umbilical incision were performed. The postoperative course was uneventful, and the patient was discharged without any complications.

DOI： 10.1111/ases.13116

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Pheochromocytomas and paragangliomas are rare tumors. A 10 year-old girl was brought to the emergency room with complaints of sudden vomiting and convulsions, and was initially diagnosed with hypertensive encephalopathy. Magnetic resonance imaging and computed tomography scan showed a large mass (6 × 3 × 3 cm) on the dorsal side of the inferior vena cava, surrounded by the right diaphragmatic crus, and closely attached to the aorta. Blood noradrenaline, urinary normetanephrine, and noradrenaline levels were elevated. The final diagnosis was retroperitoneal paraganglioma, then, surgery was contemplated. The location of the liver and great vessels in front of the tumor made the commonly performed transabdominal approach complicated. Therefore, retroperitoneoscopic surgery was preferred for safer resection, with better visualization in a sufficient space with less risk of damaging the surrounding organs. The retroperitoneoscopic approach is a good indication for tumors located behind the great vessels.

DOI： 10.1111/ases.13119

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Esophagogastric varices (EGVs) may develop as a result of portal hypertension in children with biliary atresia (BA). Although endoscopic injection sclerotherapy (EIS) with ethanolamine oleate (EO) is reported useful for children, risk factors associated with the presence of high-risk EGVs after treatment remain unknown. METHODS: The subjects were BA patients under 15 years of age who underwent EO-EIS. We retrospectively reviewed a total of 28 treatment sessions of EGVs with red signs and those larger than F2, which were considered to be at high risk of bleeding. Survival analysis was performed for the presence of high-risk EGVs at the time of follow-up endoscopy as the occurrence of an event. RESULTS: Univariate analysis showed a significantly increased risk of the presence of high-risk EGVs post-EO-EIS in patients with increased liver stiffness (LS) and Mac-2 binding protein glycan isomer (M2BPGi), with hazard ratios of 1.48 and 1.15, respectively. The median presence-free period was significantly shorter in the LS ≥ 2.8 m/sec patients than in those with LS < 2.8 m/sec (189 vs. 266 days). Similarly, the median presence-free period was significantly shorter in patients with M2BPGi ≥ 4.0 than in those with M2BPGi < 4.0 (182 vs. 203 days). The results of multivariate analysis revealed that the risk of the presence of high-risk EGVs was significantly higher only in the high-LS group, with a hazard ratio of 2.76. CONCLUSIONS: Increased LS is associated with risk of the presence of high-risk EGVs following EO-EIS in children with BA. (246 words).

DOI： 10.1111/ped.15454

Web of Science

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.46.0_52

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：公益社団法人 日本生体医工学会  

<p>【はじめに】術後成長発達する小児患者にとって、低侵襲手術は非常に重要である。しかし患者数は限られているため、しっかりとした手術を行うためにoff the job-training(OJT)が重要である。さらにOJTでの効率的な手技獲得には、手技を客観的に評価しfeed backを行うシステムが必須である。また安全で効率的な内視鏡手術を行うためには、臓器の位置関係の把握が必要であるため、術中ナビゲーションは重要な要件となる。これらの課題に対して、AIを用いた内視鏡手技評価および手術支援システムの構築に着手しており現状の成果を報告する。【方法と結果】食道閉鎖症モデルを用いた吻合手技を被験者に課し、各被験者の手技を最初に人の目で「check 表」「エラー項目」「時間」を用いて評価した。次にビデオから検出した鉗子の動きと人が判定した手技優劣の関係性をAIで学習させ、上位88％・下位95％の精度で手技優劣が自動判定可能となった。この結果を解析することで今まで必要だった50項目以上の肉眼チェックが、わずか７項目チェックするだけで手技の優劣を判断できることが明らかになった。現在食道閉鎖症の手術画像を用いて、食道・迷走神経・気管を深層学習させ、各種構造物の自動認識を進めている。【まとめ】AI画像解析により内視鏡手技の優劣をビデオで判定可能となった。この結果から新たに効率的な手技判断基準を定めることができた。術中ナビゲーションは現在精度のさらなる向上を目指している。</p>

DOI： 10.11239/jsmbe.annual61.127_2

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

A tracheoesophageal fistula (TEF) recurs in approximately 2%-13% of cases of esophageal atresia with TEF that are treated surgically. Currently, there is no consensus on the most effective treatment to prevent recurrent TEF (RTEF). Herein, we present a patient with type C esophageal atresia who underwent thoracoscopic esophago-esophageal anastomosis and TEF repair at 2 days old. However, RTEFs were observed at ages 3, 6, and 11 months, and thoracoscopic TEF repairs using a pleural patch, fascia lata graft, and pectoralis major myocutaneous (PMMC) flap were performed, respectively. A fourth recurrence led to mediastinitis, shock liver, disseminated intravascular coagulopathy, and a compromised respiratory status. Hence, laparoscopic esophageal transection was first performed to improve the respiratory condition by preventing the regurgitation of gastric contents. Once the patient was stable, a subtotal esophageal resection with TEF closure followed by gastric tube reconstruction was performed. In conclusion, we encountered a case of refractory RTEF that was repaired four times using various techniques, including a fascia lata graft and PMMC flap. However, TEF still recurred after these four operations. The final surgical strategy involved an esophageal transection as a palliative therapy, which improved the respiratory condition, followed by closure of the TEF and subtotal esophageal resection. Finally, esophageal reconstruction using a gastric tube after the complete remission of inflammation was effective. This multi-stage surgery was considered the only choice to rescue the patient and effectively prevent another recurrence.

DOI： 10.3389/fped.2022.1053154

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The urachus is an embryonic structure that connects the bladder to the allantois during early embryonic development. Occasionally, it fails to disappear at birth, leading to a case of urachal remnant (UR). This study aimed to determine whether our policy for selecting an appropriate UR resection approach is valid. We performed preoperative imaging to examine whether UR continued toward the bladder apex. If so, the UR and bladder apex were excised using the trans-umbilical approach, in addition to laparoscopy, if necessary. If preoperative imaging indicated that the UR ended near the umbilicus, the UR from the umbilicus to the duct end was resected. Pathological evaluations were performed to determine the appropriateness of the surgical approach indicated by preoperative imaging. METHODS: We retrospectively reviewed pediatric patients with UR who underwent surgery between 2015 and 2021. Their background characteristics and surgical outcomes were evaluated. RESULTS: Twenty patients with UR were included (median age, 7 [interquartile range, 2-10.25] years). UR continued toward the bladder apex in 10 patients and ended near the umbilicus in 10 patients. Urachus tissue at the bladder site was observed when the UR and bladder apex were excised. When UR was resected from the umbilicus to the duct end, urachus tissue was not pathologically detected at the resection margin. CONCLUSION: Our policy results in complete resection without excessive surgical invasion.

DOI： 10.1186/s12894-022-01153-x

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Like esophageal varices, cardiac varices are often treated with endoscopic variceal ligation (EVL). However, we previously reported that EVL for cardiac varices may be associated with a high risk of rebleeding from the ulcer if the O-ring spontaneously drops off early. The efficacy and safety of para-variceal endoscopic injection sclerotherapy (EIS) with polidocanol for the treatment of cardiac varices in children and adolescents were evaluated. METHODS: Eleven patients under 18 years of age with portal hypertension who underwent para-variceal EIS with polidocanol for cardiac varices with red signs, which were considered to be at high risk of bleeding, were retrospectively reviewed. RESULTS: One session of para-variceal polidocanol-EIS was performed for each of the 11 patients. One patient experienced temporary hypoxia due to aspiration of saliva when the tracheal intubation tube was removed after the procedure but recovered by endotracheal suctioning; there were no other adverse events. In six of the eight cases in which efficacy could be evaluated, eradication of cardiac varices was achieved. CONCLUSION: Para-variceal polidocanol-EIS may be considered instead of EVL for small cardiac varices with red signs in pediatric patients with cardiac varices.

DOI： 10.1016/j.arcped.2022.11.016

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study aimed to evaluate the efficacy of adding a spur valve to laparoscopic portoenterostomy for patients with biliary atresia. METHODS: We retrospectively reviewed the records of all patients diagnosed with biliary atresia (BA) who underwent laparoscopic portoenterostomy (Lap-PE) between 2013 and 2021. The patients were divided into two groups: Lap-PE with a spur valve (spur group) and without it (control group). Perioperative management was the same in both groups. We compared patient backgrounds and clinical outcomes, including jaundice clearance and the number of postoperative cholangitis episodes. RESULTS: Of 63 patients reviewed, 16 received a spur valve. There were no statistically significant differences in the patient backgrounds between the groups. All patients in the spur group achieved jaundice clearance. The number of postoperative cholangitis episodes one year after surgery was significantly lower in the spur group than in the control group (1 [0-3] vs. 3 [0-9], p = 0.04). The jaundice-free survival rate with the native liver at one year after surgery was significantly higher in the spur group (100% vs. 53%, p = 0.01). CONCLUSIONS: Adding a spur valve during Lap-PE significantly lowered the number of cholangitis episodes 1 year after surgery.

DOI： 10.1007/s00383-022-05230-y

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: It is important for patients with biliary atresia (BA) to retain the native liver after Kasai portoenterostomy (PE). Laparoscopic PE (Lap-PE) is standard, whereas laparoscopic revision of PE (Lap-revision) is performed as needed. We report the medium-term outcomes of Lap-revision. METHODS: We retrospectively reviewed the demographics and outcomes of 63 patients who underwent Lap-PE between 2013 and 2021. Indications for revision included recurrent jaundice, repeat cholangitis, and persistent jaundice with temporary biliary excretion following the initial PE. We compared liver transplantation (LT) data of patients who underwent Lap-revision with those of patients who did not. RESULTS: Lap-revision was performed in 20 patients. Of those 17 (excluding the two who were jaundice-free before the age of 1, and the one who underwent open conversion for bleeding), 11 (65%) were jaundice-free 1 year after Lap-revision. The surgical parameters of LT did not differ between patients who underwent Lap-revision and those who did not. CONCLUSION: Lap-revision for patients with BA had a limited but positive effect on native liver survival and did not adversely affect subsequent LT. Therefore, Lap-revision could be second-line standard therapy in patients with BA who have demonstrated biliary drainage at least once after initial PE.

DOI： 10.1007/s00383-022-05235-7

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Background: Japanese pediatric endosurgery experts conducted a workshop for young pediatric surgeons in Russia in collaboration with Russian expert pediatric surgeons. This study was aimed to develop a contributive workshop program and evaluate its impact on young pediatric surgeons. Methods: A 2-day pediatric endosurgery workshop was held in Moscow in February 2020. After conducting a needs assessment survey, Japanese and Russian faculties developed the workshop contents, including pre- and postworkshop skills assessments, lectures, and hands-on training. Skills assessments were performed using the objective skill validation system, the "A-Lap Mini," mimicking intestinal anastomosis. The trainees self-evaluated their knowledge and skills using a five-point scale. Results: Fifteen novice trainee participated and 14 (93.3%) completed the workshop program. The completion rate for the suturing task before and after the workshop was 40.0% (6/15) and 85.7% (12/14), respectively. The following five skill evaluation criteria, which were objectively evaluated: performance time changed from 751.6 ± 247.1 seconds to 780.0 ± 313.3 seconds (P > .05), number of full-thickness sutures improved from 1.0 ± 1.41 to 2.64 ± 0.84 (P = .003), area of wound-opening changed from 0.42 ± 0.83 mm2 to 0.53 ± 1.13 mm2 (P > .05), suture tension improved from 55.48% ± 19.51% to 61.95% ± 23.91% (P > .05), and maximum air leakage pressure improved from 3.76 ± 2.11 kPa to 8.42 ± 7.68 kPa (P > .05). Regarding the self-assessed questionnaire administered before and after the workshop, the confidence in endosurgery skills significantly improved as follows: forceps manipulation ability improved from 2.7 to 3.7 (P < .05), and suturing performance improved from 2.5 to 3.6 (P < .05). The usefulness of the workshop for clinical surgery was scored at 4.3. Conclusions: Quantitative skill evaluation with an automatic feedback function was useful for endosurgery training. Delivering feedback concerning the assessment results to the trainee helps them to determine the specific training requirements needed for clinical endosurgery.

DOI： 10.1089/lap.2022.0152

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Gastrointestinal bleeding (GIB) due to esophageal varices (EV) is one of the factors that negatively impact native liver survival of patients with biliary atresia (BA). Gastrointestinal fibroscopy (GIF) is usually used to determine the presence of EVs; however, it requires general anesthesia. The aim of this study is to search for markers in blood tests obtained during routine check-ups that can predict the development of GIB. METHODS: Data of patients with BA who underwent portoenterostomy at our hospital from 2014 to 2020 were retrospectively reviewed. The patients' data were assigned to three groups according to specific time points: Group B, which included data at GIB; Group NB-T, which included data at GIF and EV treatment; and Group NB-NT, which included data at GIF without treatment. The data in Group B were compared to those of other groups. RESULTS: In our study, GIB occurred in 11 patients, and 12 cases and 8 cases were classified into Groups NB-NT and NB-T, respectively. Compared with the other groups, only ChE and M2BPGi in Group B showed statistically significant differences. CONCLUSIONS: ChE and M2BPGi are useful for predicting GIB.

DOI： 10.1007/s00383-022-05243-7

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Omphalocele is a congenital abdominal wall defect of the umbilical cord insertion site. A giant omphalocele, with a fascial defect > 5 cm in diameter and/or containing > 50% of the liver within the hernia sac, can be challenging for pediatric surgeons. Recently, negative pressure wound therapy has been reported as an effective management for giant omphaloceles; however, it is not recommended for an infected wound with necrotic tissue as it may exacerbate infection. We adopted negative pressure wound therapy with irrigation and dwell time (NPWTi-d) for a case of a ruptured giant omphalocele. Artificial membranes, followed by artificial dermis, were used to promote fibrous capsule formation, and then NPWTi-d was used to promote granulation while controlling infection. However, studies have not been conducted regarding NPWTi-d for ruptured giant omphaloceles; hence, we present our treatment experience with NPWTi-d for a giant omphalocele. CASE PRESENTATION: The patient was a boy born at 38 weeks and 3 days of gestation, weighing 1896 g. He was diagnosed with a ruptured giant omphalocele with a total liver and intestine defect hole of 10 cm × 10 cm. The patient underwent silo placement using an artificial mesh, followed by plicating the artificial mesh at 4 days of age. The herniated viscera were gradually reduced into the abdominal cavity; however, the defect size was still large. Hence, a collagen-based artificial dermis was patched on the defect hole. After creating a fresh and smooth granulated tissue, NPWTi-d was applied at 33 days of age to promote granulation and control infection. We used the 3 M™ V.A.C.® Ulta Therapy Unit with 3 M™ VeraFlo™ therapy. NPWTi-d was stopped at 60 days of age when the granulation tissue was well formed including at the artificial dermis site. The wound was managed with prostandin ointment and appropriate debridement, resulting in complete epithelialization at 5 months of age. CONCLUSIONS: Artificial membranes followed by artificial dermis were used to promote a fibrous capsule and artificial dermis granulation, which protects against organ damage. NPWTi-d achieved better control of infection and promoted wound healing. NPWTi-d combined with artificial dermis can effectively treat ruptured giant omphaloceles.

DOI： 10.1186/s12887-022-03755-8

Web of Science

PubMed

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Purpose: A laparoscopic approach for malrotation is feasible and safe in hemodynamically stable neonates without intestinal necrosis; however, volvulus is associated with recurrence and conversion. We developed a novel approach using a laparoscopic duodenal-caudal detachment method to perform the Ladd procedure for neonates with volvulus under the limited view of laparoscopy. This study presents the results, effectiveness, and details of the method. Materials and Methods: In the laparoscopic duodenal-caudal detachment method, we first detached the adhesions around the duodenum, including the Ladd's band. After the adhesions were completely removed, the duodenum was freely drawn caudally, leading to the release of torsion. We retrospectively reviewed the medical records of patients who underwent surgery for malrotation of the volvulus at 30 days of age between January 2014 and September 2021. Results: Seven neonates underwent the laparoscopic duodenal-caudal detachment method and 13 underwent the open Ladd procedure. The new technique was performed in all 7 patients, and there were no conversions or recurrences. The operation time was significantly longer in the laparoscopic procedure group (55 minutes versus 111 minutes; P < .01). Conclusions: Our detorsion method, involving an initial incision of the Ladd's band, is safe and effective for neonates and may lead to an improvement in the conversion rates.

DOI： 10.1089/lap.2022.0390

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

This paper describes the fabrication and fundamental evaluation of the cubic flocked electrode (CFE), which is a dry electrode that is fabricated using electrostatic flocking technology. The development of a wearable multi-lead electrocardiogram (ECG) measurement device using the CFE is also reported. To enable the measurement of ECG signals with sufficient quality for medical applications, the occurrence of motion artifacts (MAs) is the most important problem to be overcome. Therefore, it is necessary to stabilize the contact between the patient's skin and the dry electrode. Because the CFE developed in this work offers both contact stability and flexibility, it is expected to enable ECG measurements with low MA levels. In this study, it is demonstrated that the number of MAs caused by respiration can be reduced when the CFE contact is made at a contact pressure of approximately 500 Pa using MA evaluation equipment that was developed in-house. Additionally, a wearable multi-lead ECG is designed and fabricated based on this contact pressure (500 Pa). The results of the demonstration experiment show that the ECG measurements are successful to the same extent as a conventional medical device.

DOI： 10.1038/s41598-022-24043-6

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Hernioplasty for giant inguinal hernias can cause abdominal compartment syndrome (ACS) in adults but rarely does in infants. We encountered a case of a giant bilateral inguinal hernia in infancy complicated by ACS after hernioplasty. Silo placement via a skin incision effectively treated ACS, after which the abdominal wall was safely closed. Hernioplasty performed early in the clinical course can help expand the abdominal cavity and avoid ACS. Thus, hernioplasty should be performed earlier if the hernia size in the flank space gradually increases.

DOI： 10.3389/fped.2022.1030934

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The prognosis of BA is known to be poor if definitive surgery is performed too late. Therefore, excluding BA as a diagnosis at an early stage is crucial. Conventional cholangiography requiring cannulation through the gallbladder may be unnecessarily invasive for patients, especially when ruling out BA. Therefore, a less invasive alternative such as indocyanine green (ICG) cholangiography, which does not require cannulation, should be established. In this study, we focused on excluding BA and confirmed the usefulness of intravenous ICG fluorescence cholangiography. To the best of our knowledge, this is the first preliminary study to report the use of intravenous ICG cholangiography for BA exclusion. METHODS: The study participants were patients who underwent liver biopsy and intraoperative cholangiography after they were suspected to have BA, between 2013 and 2022. ICG fluorescence cholangiography was performed on all patients who provided informed consent. RESULTS: During the study period, 88 patients underwent a laparoscopic liver biopsy and cholangiography. Among them, 65 (74%) were diagnosed with BA and underwent a subsequent laparoscopic Kasai portoenterostomy. BA was ruled out intraoperatively in 23 patients. Of the 23 patients in whom BA was ruled out, 14 underwent ICG cholangiography, 11 had gallbladder (GB) fluorescence, and 9 had both GB and common bile duct (CBD) fluorescence. Conventional cholangiography was very difficult in 2 of 23 cases: in 1 case, cannulation of the atrophic gallbladder was impossible, and cholecystectomy was indicated after multiple attempts; in 1 case, upstream cholangiography was not possible. In both cases, ICG fluorescence cholangiography successfully imaged the CBD and the GB. CONCLUSIONS: In conclusion, intravenous ICG fluorescence cholangiography might be a useful and less invasive diagnostic procedure that can rule out BA in infants.

DOI： 10.3389/fped.2022.1005879

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

This study aimed to evaluate the safety and effectiveness of circumumbilical incision (CUI) for neonates requiring intestinal anastomosis. Seventy neonates requiring intestinal anastomosis at our institution between 2003 and 2020 were included in this retrospective case-control study. Patients were classified into the CUI (25 patients: 36%) and transverse incision (TI) groups (45 patients: 64%). Postoperative complications and surgical outcomes were compared between the two groups. Intestinal perforation at the non-anastomotic site occurred significantly more often in the CUI group than in the TI group (3 patients: 12%, and 0 patients: 0%, respectively (p = 0.042)). There were no between-group differences regarding anastomotic leakages, anastomotic strictures, time to enteral feeding, operative time, and blood loss. Neonatal intestinal surgery employing CUI might be associated with increased intestinal perforation at the non-anastomotic site. Hesitating to enlarge the skin incision to maintain favorable cosmetic outcomes might cause severe injury to the delicate neonatal intestine during the surgical procedure owing to the restricted surgical field. When performing CUI, we suggest that the skin incision should be extended without hesitation whenever there is difficulty in manipulating the intestine.

DOI： 10.18999/nagjms.84.4.716

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：東京医学社  

DOI： 10.24479/ps.0000000254

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: After surgery for congenital biliary dilatation (CBD), hilar and hepatic bile duct stenosis and intrapancreatic bile duct remnants can cause many postoperative complications. We investigated the efficacy of laparoscopic surgery with aggressive bile ductoplasty and complete excision of the intrapancreatic bile duct in CBD patients compared to open surgery. METHODS: Pediatric patients who underwent surgery for CBD at our institution between 2006 and 2020 were divided into two groups: laparoscopic surgery (Lap group) and open surgery (Op group). Surgical outcomes were compared between the two groups. RESULTS: We enrolled 160 patients (85 in the Lap group and 75 in the Op group). Hilar bile ductoplasty was performed in 52 (61%) patients from the Lap group and 40 (53%) patients from the Op group. The operative time was significantly longer, the amount of blood loss was significantly lower, and the length of hospital stay was significantly shorter in the Lap group than in the Op group. Postoperative early and late complications occurred at a similarly low rate in both groups. When the surgical outcomes were compared between the group who underwent laparoscopic bile ductoplasty and the group that did not, postoperative early and late complications occurred similarly in both groups. CONCLUSIONS: Laparoscopic surgery for CBD with aggressive hilar bile ductoplasty and complete excision of the intrapancreatic bile duct is safe and effective, comparable to open surgery. However, it is necessary to verify whether long-term occurrence of hepatolithiasis similar to open definitive surgery can be obtained in the future.

DOI： 10.1007/s00464-022-09132-x

Web of Science

PubMed

Authorship：Corresponding author   Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ases.13133

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：東京医学社  

DOI： 10.24479/ps.0000000234

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：東京医学社  

DOI： 10.24479/ps.0000000238

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/PURPOSE: Congenital biliary dilatation (CBD) is a disease associated with pancreaticobiliary maljunction. The most frequent postoperative complication is intrahepatic stones, which are caused by hilar bile duct stenosis (HBDS). METHODS: We retrospectively reviewed the records of patients who underwent primary surgery for CBD between 2013 and 2021. We evaluated images and videos of HBDS, the laparoscopic technique of releasing the stenosis, and its occurrence rate and compared intraoperative bile duct findings with those of preoperative magnetic resonance cholangiopancreatography (MRCP). RESULTS: There were 87 CBD cases in this study. HBDS occurred in 52% and preoperative MRCP for HBDS showed a 96% sensitivity and 74% specificity in this study. Bile duct plasty was performed in 45% of the cases and videos demonstrated typical methods of laparoscopic bile duct plasty. The mid- to long-term complications were hepatolithiasis in three patients, anastomotic site stricture in three, and postoperative obstruction in two. CONCLUSIONS: Our study revealed that preoperative imaging studies are useful for the prediction of HBDS. Our laparoscopic meticulous probing method for finding BDS reveals more intrahepatic BDS through magnification. Therefore, this may reduce the incidence of intrahepatic stones. Preoperative imaging and intraoperative findings can be complemented to plan management that reduces long-term complications.

DOI： 10.1002/jhbp.1235

Web of Science

PubMed

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：日本メディカルセンター  

DOI： 10.19020/cg.0000002333

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Pediatric surgeons require highly advanced minimally invasive surgical skills to perform rare and complex surgeries in a very vulnerable population. We developed a neonatal esophageal atresia (EA) model to improve thoracoscopic surgical skills. This study aimed to evaluate the concurrent validity of the model by undertaking pre- and post-training skills assessments in two groups of students with no prior experience performing minimally invasive surgery, using the EA model and a dry box (DB). METHODS: A pilot study was performed. The participants were randomly divided into two groups: one trained using the DB and one trained using the EA model. Both groups practiced a minimally invasive surgical suture task. The task completion time, 29-point checklist score, modified suturing error sheet score, and three-dimensional forceps movement in both groups were compared pre-and post-training by video analysis. RESULTS: The EA model task was significantly more difficult than that of the DB. Both groups showed significant improvement in the task time, 29-point checklist score, and modified suturing error sheet score; however, the EA model training was more efficient in improving each error item. Regarding forceps movement, the EA model training significantly decreased wasted motion, whereas the DB was limited in this regard. CONCLUSIONS: Short-term training on the EA model, which was more technically demanding than the DB, decreased technical error and wasted motion, and allowed learners to acquire surgical skills more efficiently than training with the DB model. These facts revealed the concurrent validity of the EA model.

DOI： 10.1007/s00464-022-09185-y

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Esophageal atresia (EA) is often associated with tracheomalacia (TM). The severity of TM symptoms varies widely, with serious cases requiring prolonged respiratory support and surgical treatment. Although we performed thoracoscopic posterior tracheopexy (TPT) during primary EA repair to prevent or reduce the symptoms of TM, few studies have investigated the safety and effectiveness of TPT during primary EA repair. Therefore, this study aimed to evaluate the safety and efficacy of TPT in neonates. METHODS: We retrospectively reviewed the records of all patients diagnosed with TM who underwent primary thoracoscopic EA repair between 2013 and 2020 at the Nagoya University Hospital. Patients were divided into two groups: TPT (TPT group) and without TPT (control group). TPT has been performed in all patients with EA complicated by TM since 2020. We compared patient backgrounds, surgical outcomes, postoperative complications, and treatment efficacy. RESULTS: Of the 22 patients reviewed, eight were in the TPT group and 14 were in the control group. There were no statistically significant differences in the surgical outcomes between the groups (operation time: p = 0.31; blood loss: p = 0.83; time to extubation: p = 0.30; time to start enteral feeding: p = 0.19; time to start oral feeding: p = 0.43). Conversion to open thoracotomy was not performed in any case. The median operative time required for posterior tracheopexy was 10 (8-15) min. There were no statistically significant differences in postoperative complications between the groups (chylothorax: p = 0.36; leakage: p = 1.00; stricture: p = 0.53). The respiratory dependence rate 30 days postoperative (2 [25%] vs. 11 [79%], p = 0.03) and the ratio of the lateral and anterior-posterior diameter of the trachea (LAR) were significantly lower in the TPT group (1.83 [1.66-2.78] vs. 3.59 [1.80-7.70], p = 0.01). CONCLUSIONS: TPT during primary EA repair for treatment of TM significantly lowered respiratory dependence rate at 30 days postoperative without increasing the risk of postoperative complications. This study suggested that TPT could improve TM associated with EA.

DOI： 10.1186/s12893-022-01738-1

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Laparoscopic definitive surgery for choledochal cyst (CC) in infants requires advanced skills because of their small size. If patients with a prenatal diagnosis of CC have any biliary symptoms, they need semi-emergency definitive surgery. This study aimed to estimate whether laparoscopic definitive surgery for CC can be performed safely and effectively in infants, especially when emergency surgery is required. PATIENTS AND METHODS: From January 2006 to December 2019, 21 patients under 1 year of age underwent laparoscopically or open definitive surgery, and 16 patients aged 3-5 years underwent laparoscopic surgery for CC at our institution. In cases of prenatal diagnosis, elective surgery (EL) was performed at about 6 months of age for patients with no biliary symptoms; the semi-emergency surgery (EM) was performed when patients had any biliary symptoms. Surgical outcomes were retrospectively compared between the Lap <1 y and Op <1 y groups and between the Lap <1 y and Lap 3-5 y groups. In addition, the surgical outcomes of those who underwent EM were also evaluated. RESULTS: Operative time was significantly longer, and blood loss was significantly lower in the Lap <1 y group than in the Op <1 y group. All surgical outcomes were similar between the Lap <1 y and Lap 3-5 y groups and between the EM and EL groups. CONCLUSION: Laparoscopic definitive surgery for CC in infants under 1 year of age is safe and feasible. Even semi-emergency laparoscopic surgery can be performed safely and effectively in small infants.

DOI： 10.4103/jmas.JMAS_98_21

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Though gastric volvulus in neonates and infants resolves by conservative therapy and aging, some cases require surgical intervention. This study aimed to review the cases of gastric volvulus requiring surgical intervention and evaluate their characteristics. METHODS: We retrospectively reviewed gastric volvulus cases requiring surgical intervention. Surgical indication was persistent acute gastric volvulus and repeated hospitalization for gastric volvulus. We evaluated the characteristics of those cases requiring surgical intervention and the surgical results of laparoscopic gastropexy. RESULTS: The median age of patients included was 4 years (range: 1-6 years). All eight cases of gastric volvulus requiring sugery had congenital spleen diseases. Six of the eight cases suffered from a wandering spleen, while two cases presented with situs inversus with asplenia. Both splenopexy (preperitoneal distension balloon [PDB] or blunt separaion methods) and gastropexy were performed in cases with wandering spleen. No postoperative complications were reported in any of the eight cases, except the recurrence of gastric volvulus due to suture shedding in one case. CONCLUSION: Laparoscopic gastropexy for gastric volvulus and splenopexy for cases concomitant with wandering spleen were found to be effective surgical approaches. Both PDB and blunt separation methods for making extraperitoneal pockets for the spleen were employed successfully.

DOI： 10.1007/s00383-022-05125-y

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Biliary atresia (BA) is among the commonest indications for liver transplantation (LT) in children. We examined whether serum matrix metalloproteinase-7 (MMP-7) is useful for diagnosis of BA in Japanese infants, and whether serum MMP-7 concentrations before and after Kasai portoenterostomy (KP) predicted LT within a year. METHODS: Subjects under 6 months old at eight pediatric centers in Japan were enrolled retrospectively, including patients with cholestasis and normal controls (NC) without liver disease. Patients with cholestasis were divided into groups representing BA versus cholestasis from other causes (non-BA). Serum samples were collected from patients with BA at diagnosis and 1 and 4 weeks after KP, as well as from non-BA and NC. RESULTS: Serum MMP-7 concentrations were significantly higher in BA at diagnosis (median, 89.1 ng/ml) than in non-BA (11.0; p < 0.001) or NC (10.3; p < 0.001). Receiver operating characteristic (ROC) analysis of MMP-7 for BA versus non-BA yielded an area under the ROC curve of 0.99 (95% confidence interval, 0.96-1.00). An optimal cut-off value of 18.6 ng/ml for serum MMP-7 in diagnosing BA demonstrated sensitivity and specificity of 100% and 90%, respectively. Serum MMP-7 before and 1 week and 4 weeks after KP did not differ significantly between BA requiring only KP and BA requiring LT after KP. CONCLUSION: Serum MMP-7 is a useful marker for diagnosis of BA in Japanese infants, but it could not predict LT within a year.

DOI： 10.1111/hepr.13753

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The purpose of this study was to evaluate the utility of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients with pancreaticobiliary diseases. METHODS: A retrospective review was performed on patients who underwent ERCP for the treatment of biliary tract disease and detailed examination of pancreatitis at our institution from January 1999 to December 2020. RESULTS: ERCP was performed for congenital biliary dilatation (CBD) (n = 42), choledocholithiasis (n = 9), common bile duct stenosis (n = 1), and several types of pancreatitis (n = 13). The only severe complication of ERCP was common bile duct injury. Three (5.8%) of 52 biliary diseases failed to be treated by ERCP. All patients with pancreatic disease were correctly diagnosed and treated. CONCLUSIONS: Endoscopic biliary drainage with a temporary stent was adequate for symptomatic relief in CBD. Stenting of the pancreatic duct was useful for improving the angulation and drainage of the pancreatic duct. ERCP was useful for understanding the anatomy of the pancreatic duct and revealing potential treatments. Therefore, ERCP and transendoscopic therapy are sufficiently feasible in pediatric patients and should be actively introduced for the investigation and treatment of pancreaticobiliary diseases.

DOI： 10.1186/s12887-022-03207-3

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：東京医学社  

DOI： 10.24479/pm.0000000090

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

We reviewed the outcomes of meconium peritonitis and evaluated the safety and feasibility of primary radical surgery for meconium peritonitis. A total of 21 cases of meconium peritonitis between 2006 and 2020 were retrospectively reviewed. The patients were classified into two groups based on the type of surgery: group I (primary radical surgery, n = 16) and group II (multistage surgery; drainage only or ileostomy, followed by elective surgery, n = 5). Patient backgrounds and surgical outcomes were compared between the two groups. The term of prenatal diagnosis, preoperative white blood cell count, and preoperative catecholamine use were not significantly different between the two groups. Group I included more mature neonates than group II (gestational age at birth, 35w1d vs 30w1d, p = 0.02; birth weight, 2.5 kg vs 1.1 kg, p < 0.01). Preoperative C-reactive protein was significantly lower in group I (0.37 mg/dL vs 2.8 mg/dL, p < 0.05). Operation time, blood loss, time to enteral feeding, and complication rates were not significantly different between the two groups. The surgical outcomes of primary radical surgery were comparable to those of multistage surgery, although the patients' backgrounds were different. Our strategy of selecting one-stage or multiple-stage surgery for treatment of meconium peritonitis, depending on the patient's general condition and degree of intestinal ischemia, was reasonable.

DOI： 10.18999/nagjms.84.1.148

Web of Science

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本小児外科学会  

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.4240/wjgs.v14.i1.56

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.45.0_77

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.45.0_74

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1117/12.2611441

Web of Science

Language：English   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2022081278

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

Massive splenomegaly and hypersplenism in patients with biliary atresia after Kasai portoenterostomy were treated with partial splenic embolization or total splenectomy. We performed partial splenectomy to reduce the complications of partial splenic embolization and avoid overwhelming post-splenectomy infection. This study aimed to evaluate the long-term effects of partial splenectomy for hypersplenism on postoperative liver and spleen function in patients with biliary atresia. Among jaundice-free patients with biliary atresia who underwent Kasai portoenterostomy between January 1992 and December 2012, 15 underwent partial splenectomy for massive splenomegaly and hypersplenism at our institution. Changes in the laboratory data 10 years post partial splenectomy were retrospectively investigated, and these along with the latest data were measured. A total of four patients (27%) required living-donor liver transplantation after partial splenectomy, a proportion similar to those who did not undergo partial splenectomy. Compared to the preoperative baseline, the platelet counts were significantly higher at 1 and 3 years after surgery (p < 0.05). Aspartic aminotransferase-to-platelet ratio index was significantly lower at 1, 7, and 10 years after partial splenectomy (p < 0.05). No further surgeries were required for hypersplenism after partial splenectomy over 10 years, and there were no cases of overwhelming post-splenectomy infection after partial splenectomy. Partial splenectomy is safe and effective for the treatment of hypersplenism with biliary atresia over a long time period. It could be considered as an alternative to partial splenic embolization as it can suppress hypersplenism for a long time and induces fewer postoperative complications.

DOI： 10.18999/nagjms.83.4.765

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)   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

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   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

Web of Science

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)   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

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本小児栄養消化器肝臓学会  

Language：Japanese   Publishing type：Research paper (scientific journal)   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

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Pediatric Surgery International  

Purpose: The effectiveness of laparoscopic Kasai portoenterostomy (Laparoscopic-KPE) for biliary atresia (BA) has been reported but remains controversial. We reviewed our own cases and cases described in previous studies of liver transplantation (LT) for BA after Laparoscopic-KPE to investigate the efficacy of Laparoscopic-KPE. Methods: Subjects were children of ≤ 2 years old with LT for BA after KPE who underwent Laparoscopic-KPE (n = 10) or Open-KPE (n = 115) between 2009 and 2020. Propensity score matching was performed to reduce the effect of treatment selection bias. The clinical data regarding the preoperative characteristics and surgical results were compared. Results: The rates of hypoplastic portal vein and retrograde portal vein flow were lower in the Laparoscopic-KPE group than in the Open-KPE group (0 vs. 40.0%, p = 0.02 and 0 vs. 35.0%, p = 0.04). There was no marked difference in the operation time or duration of hepatectomy. For portal vein reconstruction, a vein graft was not required in the Laparoscopic-KPE group (0 vs. 35.0%, p = 0.03). No patients in the Laparoscopic-KPE group developed portal vein complications or required re-laparotomy for bowel perforation or re-bleeding, in contrast to the Open-KPE group (0 vs. 15.0% and 0 vs. 10.0%, respectively). Conclusion: Laparoscopic-KPE may reduce postoperative complications that necessitate re-laparotomy in LT.

DOI： 10.1007/s00383-021-04994-z

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   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

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Pediatric Surgery International  

Background: Minimally invasive surgery (MIS) is appropriate for the treatment of some neuroblastomas (NBs); however, the indications and technical issues are unclear. This study aimed to clarify the current status of MIS for mediastinal NB in Japan. Methods: Preliminary questionnaires requesting the numbers of neuroblastoma cases in which MIS was performed from 2004 to 2016 were sent to 159 Japanese institutes of pediatric surgery. Secondary questionnaires were sent to institutions with MIS cases to collect detailed data. Results: One hundred thirty-four (84.2%) institutions returned the preliminary questionnaire and 83 institutions (52.2%) reported a total of 1496 operative cases. MIS was performed for 175 (11.6%) cases. Among the 175 cases, completed forms of 140 patients were returned and 40 (male, n = 28; female, n = 12) cases had mediastinal NB. Fourteen patients received thoracoscopic biopsy, none were converted to thoracotomy. Twenty-eight patients received MIS for radical resection, none were converted to thoracotomy. Perioperative complications (Horner’s syndrome) were recognized after radical resection in one (2.5%) case. Conclusions: MIS was performed in a limited number of mediastinal NB cases. A thoracoscopic approach would be feasible for mediastinal NB.

DOI： 10.1007/s00383-021-04998-9

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   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

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Nagoya Journal of Medical Science  

A 45-year-old female was admitted to the hospital with a diagnosis of acute pancreatitis. A computed tomography scan showed two extrahepatic bile ducts. Magnetic resonance cholangiopancreatography suggested a stone in one of the bile ducts. Endoscopic retrograde cholangiopancreatography revealed two extrahepatic bile ducts joining at the hilum of the liver accompanied with pancreaticobiliary maljunction. Sphincterotomy was performed and a protein plug was drained from the bile duct. Several treatment options were discussed, and the patient was treated with laparoscopic cholecystectomy without extrahepatic bile duct resection and planned to be followed up considering the risk of carcinogenesis in the bile ducts.

DOI： 10.18999/nagjms.83.3.655

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)  

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Familial Cancer  

Hereditary leiomyomatosis and renal cell cancer (HLRCC) is caused by heterozygous germline variants in the fumarate hydratase (FH) gene and is associated with increased susceptibility to cutaneous leiomyomas, uterine leiomyomas, and renal cell carcinoma (RCC). HLRCC-associated RCC usually occurs in the middle age, with the median age being 40–44 years. This report describes a seven-year-old (84-month-old) male who developed a large right kidney tumor with multiple cystic lesions that contained enhanced solid components. There was no evidence of distant metastasis. The male patient underwent right nephrectomy and has been recovering well without metastasis or recurrence. Pathological examination revealed that tumor cells with relatively prominent nucleoli and surrounded by halos, were located in a limited area. Immunohistochemical staining was negative for FH. Whole-exome sequencing identified his germline variant in the FH gene and its loss of heterozygosity in the tumor. At nine years (114 months) of age, the male patient showed no recurrence of the tumor. This was the youngest-onset case of HLRCC-associated RCC to date. This report may affect the starting age for future RCC-surveillance programs for patients with HLRCC.

DOI： 10.1007/s10689-021-00268-8

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Surgical Endoscopy  

Background: Some neuroblastoma (NB) cases are suitable for minimally invasive surgery (MIS), but indication and technical issue are unclear. We assessed the current status of MIS for abdominal NB after mass screening period in Japan. Methods: Preliminary questionnaires requesting the numbers of NB cases that underwent MIS from 2004 to 2016 were sent to 159 Japanese institutes of pediatric surgery. The secondary questionnaires were then sent to the institutions that reported MIS cases of NB in order to collect detailed data. Results: One hundred and thirty-four (84.2%) institutions responded to the preliminary questionnaires, and 83 (52.2%) reported managing operative cases. The total number of operative cases was 1496. MIS was performed for 175 (11.6%) cases, of which the completed forms of 140 patients were returned, including 100 abdominal NB cases. The male/female ratio was 51/49. Forty-seven cases underwent a laparoscopic biopsy, and 2 (4.3%) cases were converted to laparotomy due to bleeding. Sixty-five cases underwent MIS for radical resection, and 7 (10.8%) were converted to laparotomy. The reasons for open conversion were bleeding and severe adhesion. Regarding open conversion, there were no significant relationships between conversion and neo-adjuvant chemotherapy, biopsies, stage, size, or MYCN amplification. We found no relationship between resectability and vascular encasement in this study. There was relationship between the resected tumor size and the patients’ height, which was expressed using the following formula: y= 0.0316 x+ 1.4812 (x, patients height, y, tumor size; p = 0.004219, SE: 1.55566). Postoperative complications after radical resection were recognized in 7 (10.8%) cases. Conclusions: MIS was performed in limited cases of abdominal NB. A laparoscopic biopsy with careful attention to bleeding is feasible. The resected tumor size was shown to correlate with the patients’ height. Tumor size within 6 cm of maximum diameter can be resected safely.

DOI： 10.1007/s00464-021-08599-4

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   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

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)  

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本小児外科学会  

Language：Japanese   Publishing type：Research paper (scientific journal)   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

Web of Science

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021229976

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1200/JCO.2021.39.15_suppl.e22008

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)   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   Publishing type：Research paper (scientific journal)   Publisher：Scientific Reports  

Diagnosis of biliary atresia (BA) can involve uncertainties. In the present prospective multicenter study, we considered whether urinary oxysterols represent a useful marker for diagnosis of BA in Japanese children. Subjects under 6 months old at 7 pediatric centers in Japan were prospectively enrolled, including patients with cholestasis and healthy controls (HC) without liver disease. Patients with cholestasis constituted 2 groups representing BA patients and others with cholestasis from other causes (non-BA). We quantitatively analyzed 7 oxysterols including 4β-, 20(S)-, 22(S)-, 22(R)-, 24(S)-, 25-, and 27-hydroxycholesterol by liquid chromatography/electrospray ionization-tandem mass spectrometry. Enrolled subjects included 14 with BA (median age 68 days; range 26–170) and 10 non-BA cholestatic controls (59; 14–162), as well as 10 HC (57; 25–120). Total urinary oxysterols were significantly greater in BA (median, 153.0 μmol/mol creatinine; range 24.1–486.7; P < 0.001) and non-BA (36.2; 5.8–411.3; P < 0.05) than in HC (2.7; 0.8–7.6). In patients with BA, urinary 27-hydroxycholesterol (3.61; 0.42–11.09; P < 0.01) was significantly greater than in non-BA (0.71; 0–5.62). In receiver operating characteristic (ROC) curve analysis for distinguishing BA from non-BA, the area under the ROC curve for urinary 27-hydroxycholesterol was 0.83. In conclusion, this first report of urinary oxysterol analysis in patients with BA indicated that 27-hydroxycholesterol may be a useful marker for distinguishing BA from other causes of neonatal cholestasis.

DOI： 10.1038/s41598-021-84445-w

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   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

Web of Science

Scopus

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-020-04791-0

Web of Science

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-020-04793-y

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Nagoya Journal of Medical Science  

Early detection of diseases is critical in infants. This study evaluates the usefulness of web searches in predicting diseases in order to encourage guardians to consult a doctor promptly if their children are ill. We collected six months of search queries from Yahoo! JAPAN Search between October 2016 and March 2017. Using a machine learning model, we investigated the accuracy of the search query’s ability to predict the diagnosis of biliary atresia and hypertrophic pyloric stenosis. Both diseases were modeled with an accuracy of approximately 80&, and symptoms related to the disease were significant features in the model. These findings suggest the possibility of detecting diseases from web search queries performed by guardians. Through future research, we intend to propose a method that uses web search queries for early detection of these diseases by providing appropriate and timely information to support the guardians of patients.

DOI： 10.18999/nagjms.83.1.107

Web of Science

Scopus

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   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

Language：Japanese   Publishing type：Research paper (scientific journal)   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

Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：SPIE  

DOI： 10.1117/12.2581261

Web of Science

Scopus

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.44.0_50

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.44.0_72

CiNii Research

Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：Springer  

DOI： 10.1007/978-3-030-90874-4_1

Web of Science

Other Link： https://dblp.uni-trier.de/db/conf/clip-ws/clip2019.html#OdaHKTHUSOM21

Language：English   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021085587

CiNii Research

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12893-020-00986-3

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)  

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本門脈圧亢進症学会  

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12887-020-02183-w

Web of Science

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10147-020-01620-1

Web of Science

Language：English   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2020230886

CiNii Research

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.compbiomed.2019.103471

Web of Science

Publishing type：Research paper (scientific journal)  

Web of Science

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.43.0_84

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.43.0_36

Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：SPIE-INT SOC OPTICAL ENGINEERING  

This paper presents a visualization method of intestine (the small and large intestines) regions and their stenosed parts caused by ileus from CT volumes. Since it is difficult for non-expert clinicians to find stenosed parts, the intestine and its stenosed parts should be visualized intuitively. Furthermore, the intestine regions of ileus cases are quite hard to be segmented. The proposed method segments intestine regions by 3D FCN (3D U-Net). Intestine regions are quite difficult to be segmented in ileus cases since the inside the intestine is filled with fluids. These fluids have similar intensities with intestinal wall on 3D CT volumes. We segment the intestine regions by using 3D U-Net trained by a weak annotation approach. Weak-annotation makes possible to train the 3D U-Net with small manually-traced label images of the intestine. This avoids us to prepare many annotation labels of the intestine that has long and winding shape. Each intestine segment is volume-rendered and colored based on the distance from its endpoint in volume rendering. Stenosed parts (disjoint points of an intestine segment) can be easily identified on such visualization. In the experiments, we showed that stenosed parts were intuitively visualized as endpoints of segmented regions, which are colored by red or blue.

DOI： 10.1117/12.2548910

Web of Science

Scopus

Other Link： https://dblp.uni-trier.de/db/journals/corr/corr2003.html#abs-2003-01290

Publishing type：Research paper (scientific journal)  

Web of Science

Language：English   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2020041175

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41598-019-51123-x

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-019-04541-x

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-019-04537-7

Web of Science

PubMed

Publishing type：Research paper (scientific journal)  

Web of Science

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00464-019-07108-y

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/hepr.13381

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2019185000

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

To develop a wearable multi-lead electrocardiogram (ECG) measuring system, we fabricated the electrodes and wires by using electrostatic flocking technology on a textile. By using this technology, it was possible to fabricate many electrodes and wires, simultaneously. Also the flocked electrodes and wires had stretchability and washing resistance properties. To use dry electrodes, it is important to reduce the influence of motion artifacts (MAs). The results of the experiment with the skin phantom revealed that the contact pressure between the skin and the electrode is an important factor in MA reduction. Then, we conducted experiments with a human body to determine the relationship between the contact pressure and the MAs. Under the pressures of 200 Pa and 500 Pa, MAs were observed. Meanwhile, under the pressures of 1000 Pa, 2000Pa and 4000 Pa, the ECG signals under rest and deep breathing conditions were able to be measured without MAs. Considering the comfortability, the contact pressure from 1000 Pa to 2000 is preferable. Finally, we fabricated the wearable ECG measuring system and succeeded in measuring 18-lead ECG signals. The measured ECG waveform is in good agreement with the ECG waveform measured by a commercial system.

DOI： 10.1038/s41598-019-42027-x

Web of Science

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：一般社団法人エレクトロニクス実装学会  

<p>心電図モニタリング用のドライ電極の開発を行った。ドライ電極を用いた心電図モニタリングにおいての課題は皮膚-電極間の安定した接触である。我々は立体構造の樹脂に銀メッキ加工を施した繊維を静電植毛することにより、体の形状に沿った形状であり、皮膚-電極間の安定した接触を実現した、ドライ電極の作製を行った。また作製したドライ電極を用いて心電図モニタリングウェアを作製し、医療的意義のある心電図測定に成功した。</p>

DOI： 10.11486/ejisso.33.0_13a2-01

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：公益社団法人 日本生体医工学会  

<p>腹腔鏡手術は低侵襲性であることから普及が進んでいる。しかしながら、カメラを通じた状況把握、ポート留置部を支点とするため移動方向が手の動きと逆になる腹腔鏡用鉗子の利用など、手術の難易度が高く、習得に時間がかかることことから熟練者不足が問題となっている。また熟練医の不足は修練者のための教育に当てる時間も不足するという悪循環を生んでいる。従って、熟練者を短期間で養成し増やすための術式教育そのものが重要な課題である。本研究では、内視鏡外科手術は術野像がモニタによって同じ視野が「共有される」という特性を利用して、段階的な学習ステップに応じた、熟練者の適切かつスムースな動きを修練者が追体験することで、非言語的なスキルの伝達を行い、効果的なトレーニングを行うシステムである「追いトレ」を用いた場合の効果について、妥当性、効果の範囲、適応可能な範囲を明らかし、製品化・実用化・普及を実現するエビデンスを獲得するために、様々な内視鏡外科分野で十分な検証実験を踏まえたデータ取得とデータ解析を行なうことを目的とした。</p>

DOI： 10.11239/jsmbe.Annual57.S198_1

Language：English   Publishing type：Research paper (other academic)   Publisher：Springer  

DOI： 10.1007/978-3-030-32689-0_11

Web of Science

Other Link： https://dblp.uni-trier.de/db/conf/miccai/clip2019.html#OdaNKVACHUSIOM19

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.bjps.2018.12.027

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.crad.2018.08.008

Web of Science

Other Link： http://orcid.org/0000-0002-1818-6697

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Tokyo  

Total esophagogastric dissociation (TED) is used to treat gastroesophageal reflux (GER) after failed fundoplication in neurologically impaired patients. It is now performed for some otherwise healthy patients with severe GER. In this procedure, the gastrointestinal tract is reconstructed in a non-physiological way with a Roux-en-Y esophagojejunal anastomosis and jejuno-jejunostomy. Although TED eliminates almost all GER, some patients experience late complications. In this review, we investigated the long-term outcomes after TED to determine the best indications. In total, 147 neurologically impaired patients and 28 neurologically normal patients were identified. The total rate of complications requiring re-operation was 17.2% in neurologically impaired patients and 32.1% in normal patients, both higher than the rates associated with fundoplication. Although most authors added pyloroplasty when there was a concern of gastric emptying, this sometimes caused bile reflux. Nutritional and metabolic complications, including dumping syndrome and chronic digestive malabsorption, were also reported to occur after TED. TED is an option for the treatment of neurologically impaired patients with recurrent GER after fundoplication or who are at a high risk of recurrence of GER with fundoplication. However, neurologically normal patients who have the ability to obtain nutrition orally should consider options other than TED, as postoperative complications are frequent.

DOI： 10.1007/s00595-018-1636-9

Web of Science

Scopus

PubMed

Other Link： http://orcid.org/0000-0002-1818-6697

Language：English   Publishing type：Research paper (scientific journal)  

Gastrostomy is often performed with fundoplication in handicapped children. We devised a new laparoscopic triangle fixation technique for gastrostomy. In this study, 100 patients underwent gastrostomy with fundoplication between January 2008 and January 2016. We retrospectively reviewed the early postoperative results between the new laparoscopic procedure (NLP) group (n = 63) and conventional procedure (CP) group (n = 37). In the CP, the gastrostomy tube was inserted with a purse-string ligature at the gastric wall, and the gastric wall was sutured to the peritoneum under a small laparotomy. In NLP, three sutures were placed on the gastric wall, forming the three sides of a triangle, and the tube was inserted into the center of the triangle. The ends of each suture were pulled directly through the abdominal wall using a laparoscopic percutaneous extraperitoneal closure needle to join the gastric wall and peritoneum. Both groups showed no significant differences in age, body weight, and external leakage rate. The wound infection rate was significantly lower in the NLP group. In conclusions, the NLP is straightforward and can achieve firm fixation between the stomach and abdominal wall by suturing in the form of a triangle. The NLP was associated with a lower complication rate, especially concerning infection.

DOI： 10.18999/nagjms.80.4.497

Web of Science

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1089/lap.2018.0330

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The Soave procedure (SO) is performed most commonly for Hirschsprung disease. SO reduces the risk of injury to the pelvic structures; however, a residual aganglionic muscle cuff could interfere with bowel movement and lead to obstructive enterocolitis. The Swenson procedure is considered ideal in terms of peristalsis. Currently, laparoscopic surgery provides better visualization and facilitates precise dissection, possibly leading to feasible performance of the laparoscopic modified Swenson procedure (SW). We present our operative technique and the efficacy of the SW compared with that of SO. METHODS: We retrospectively reviewed the records of 16 and 27 patients who underwent SW and SO, respectively, between 2012 and 2017. RESULTS: Operative time, blood loss, length of stay, and frequency of bowel movements showed no significant difference between the two groups. In the SW group, temporary dysuria occurred in one patient, postoperative enterocolitis in two, wound infection in one, and severe perianal excoriation in four, whereas in the SO group, obstructive symptoms occurred in three patients, small-bowel obstruction in one, and severe perianal excoriation in three. The complications and outcomes were comparable between both groups. CONCLUSION: Laparoscopic SW was safe and feasible for the short-term follow-up outcomes.

DOI： 10.1007/s00383-018-4318-1

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-018-4313-6

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

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

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

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

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: We previously showed that meticulous probing and resection of the intrahepatic bile duct stenosis (IHBDS)-causing membrane or septum was effective in preventing hepatolithiasis after choledochal cyst excisions in open surgeries. Then, we introduced this maneuver into laparoscopic choledochal cyst excisions in 2014 and performed routine resections since then. The aim of this study was to show the feasibility of this method in laparoscopic surgery. METHODS: We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic choledochal cyst excisions at our hospital between January 2014 and December 2017. The patients who underwent surgical treatment for IHBDS-causing membrane or septum were compared with those who did not undergo the procedure. The outcomes of the patients with IHBDS were also compared between patients who were ≥ 3 years of age and those < 3 years at operation. RESULTS: Seventeen of 35 patients underwent laparoscopic resection of IHBDS-causing membrane or septum. There were no complications related to the procedure although the operative time and intraoperative bleeding amount increased in the patients with IHBDS who were ≥ 3 years of age. CONCLUSIONS: Meticulous probing and excision of the IHBDS-causing membrane or septum is safe and feasible during laparoscopic choledochal cyst excision.

DOI： 10.1007/s00383-018-4320-7

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The purpose of this study is to clarify the impact of body weight on outcomes of stapled anastomosis in pediatric patients. METHODS: A total of 253 pediatric patients who underwent intestinal anastomosis were classified according to body weight (<3.5 kg: light group, ≥3.5 kg: heavy group), and clinical outcomes of stapled and hand-sewn anastomoses were compared. RESULTS: The light and heavy groups included 77 (stapled: n = 13, hand-sewn: n = 64) and 176 (stapled: n = 58, hand-sewn: n = 118) patients, respectively. In both groups, stapled anastomosis was associated with reduced time to initial oral feeding (light group: 4 vs. 7 days, p = 0.006; heavy group: 3 vs. 5 days, p < 0.001) and full feeding (light group: 12 vs. 16 days, p = 0.026; heavy group: 7 vs. 9 days, p = 0.001), whereas its complication rate was not significantly different from that of hand-sewn anastomosis (light group: 30.8 vs. 12.5%, p = 0.112; heavy group: 3.4 vs. 2.5%, p = 0.665). In patients who underwent stapled anastomosis, the complication rate was significantly higher in the light group (30.8 vs. 3.4%, p = 0.009), with two cases of volvulus related to anastomotic dilatation. CONCLUSIONS: Stapled anastomosis is an effective procedure facilitating prompt oral feeding. However, the risk of complications, including volvulus related to anastomotic dilatation, should be considered among patients weighing <3.5 kg. LEVEL OF EVIDENCE: III.

DOI： 10.1016/j.jpedsurg.2018.04.030

Web of Science

PubMed

Language：English   Publishing type：Research paper (other academic)  

Language：English   Publishing type：Research paper (other academic)  

Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：Institute of Electrical and Electronics Engineers Inc.  

We developed textile-based multi-lead ECG measurement wear. The textile-based ECG measurement wear was fabricated by printed electronics and electrostatic flocking technology. We also developed a wireless communication system of multi-lead ECG signals. Moreover, we succeeded to get 18-lead ECG signals around heart using the ECG measurement wear and the wireless measuring system.

DOI： 10.23919/ICEP.2018.8374690

Scopus

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Postoperative chylothorax after surgery for esophageal atresia/tracheoesophageal fistula (TEF) is a rare but serious complication, especially in neonates. This study aimed to identify the thoracic duct and ligate chylous leakage sites, using thoracoscopic navigation of an indocyanine-green (ICG)-based near-infrared (NIR) fluorescence imaging system. METHODS: From November 2014 to April 2017, thoracoscopic intraoperative ICG-NIR imaging was performed in 10 newborns (11 surgeries) with first TEF operation or with persistent postoperative chylothorax after TEF operation. NIR imaging was performed 1h after an inter-toe injection of ICG. Thoracoscopic ligations against the NIR-detected leakage sites were performed with sutures. RESULTS: The thoracic duct or lymphatic leakage was directly visualized in each patient. In 8 surgeries with first thoracoscopic TEF operation, one case had suspected minor chylous leakage without postoperative chylothorax. Another case with no chylous leakage at the first operation resulted in chylothorax at postoperative day 11. In three neonates with postoperative chylothorax, leakage points were detected near the ablation site of the azygos vein during the first operation. These points were properly ligated, and postoperative chylous leakage ceased with no adverse events. CONCLUSIONS: Thoracoscopic ICG-NIR imaging encourages the repair of refractory chylothorax and seems reliable. LEVEL OF EVIDENCE: IV.

DOI： 10.1016/j.jpedsurg.2018.01.019

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：金原出版  

DOI： 10.18888/op.0000000707

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpeds.2017.12.058

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Pediatric robot-assisted surgery is increasingly being performed, but it is difficult to perform this procedure in infants. A pediatric thoracoscopic model of a 1-year-old patient was developed in our previous study, and this model was used to evaluate the use of a surgical robot for infant surgery. METHODS: Eight pediatric surgeons performed an intracorporeal suturing and knot-tying task using the da Vinci Xi Robotic Surgical System. The task completion time, number of needle manipulations, and force applied during suturing of the robot-assisted thoracoscopic surgery (RATS) group were compared with those of the video-assisted thoracoscopic surgery (VATS) group whose data had been collected from the same 8 surgeons in our previous study. RESULTS: The RATS group showed a significantly shorter completion time than the VATS group in the knot-tying phase (P = .016) and in the total phase (P = .0078). The RATS group showed a significantly smaller number of manipulations than the VATS group in the total phase (P = .039). The RATS group showed a significantly smaller pushing force index than the VATS group in the suturing phase (P = .031), knot-tying phase (P = .031), and in the total phase (P = .031). A seventh rib in the model was dislocated in all RATS group cases. CONCLUSIONS: The da Vinci Surgical System might be useful in infants because of fast movement and small pushing force. However, the robotic 8 mm instruments were too large for use in the thoracic cavity of the 1-year-old infant.

DOI： 10.1089/lap.2017.0307

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Emergency rescue lung resection is rarely performed to treat congenital lung cysts (CLCs) in neonates. Many reports have described fetal CLC treatment; however, prenatal predictors for postnatal respiratory failure have not been characterized. We hypothesized that fetal imaging findings are useful predictors of emergency surgery. METHODS: We retrospectively studied patients with CLC who underwent lung surgery during the neonatal period in our hospital between January 2001 and December 2015. The demographic data, fetal imaging findings, and intra- and postoperative courses of patients who underwent emergency surgery (Em group) were compared with those of patients who received elective surgery, i.e., non-emergency surgery (Ne group). RESULTS: The Em group and Ne group included 7 and 11 patients, respectively. No significant difference was noted in gestational age, time at prenatal diagnosis, birth weight, and body weight at surgery. The volumes of contralateral lung per thoracic volume were significantly smaller in the Em group than in the Ne group (p = 0.0188). Mediastinal compression was more common in the Em group (7/7) than in the Ne group (4/11) (p = 0.0128). CONCLUSIONS: This is the report describing neonatal emergency lobectomy in patients with CLC evaluated by fetal MRI using the lung volume ratio and mediastinal shift. In patients with CLC, mediastinal shift and significant decreases in contralateral lung volumes during the fetal stages are good prenatal predictors of postnatal emergency lung resection.

DOI： 10.1186/s12887-018-1085-z

Web of Science

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japan Institute of Electronics Packaging  

DOI： 10.11486/ejisso.32.0_179

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Pediatric Surgeons  

<p>The patient was a 5-year-old boy who had no medical history. He was referred to us with suspected acute appendicitis and complaints of fever and lower abdominal pain. Although his abdominal pain was intense, rebound tenderness and muscular protection were negative. There were no symptoms of problems in the digestive tract such as vomiting or diarrhea. His blood examination revealed an increase in inflammatory reactions, as indicated by the increased white blood cell count and C-reactive protein levels. Computed tomography (CT) revealed wall thickening of the ascending colon; therefore, we started antibiotic administration after acute enterocolitis was diagnosed. After admission, we performed CT again and found a fatty and dense mass with a swirling structure inside the mass; therefore, we diagnosed the patient as having idiopathic omental torsion. Because the symptoms were relieved, conservative management was continued and the patient was discharged on the fourth day after hospitalization. Omental torsion is a rare condition, particularly seen in children; its classical treatment option is surgery. Although conservative management was successful in this case, there are few reports on it. There are many cases where surgery is performed after an initial diagnosis of acute appendicitis is made owing to the presence of similar symptoms. However, in recent years, because of advances in imaging diagnostic techniques such as CT, more patients are being accurately diagnosed. We believe that if patients are accurately diagnosed, surgery will always be required; however, conservative management is sometimes possible.</p>

DOI： 10.11164/jjsps.54.2_302

Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/978-3-030-00934-2_26

Web of Science

Scopus

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpedsurg.2017.08.056

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12893-017-0313-z

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpedsurg.2017.10.061

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.18999/nagjms.79.4.427

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-017-4140-1

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/08941939.2017.1366603

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.18999/nagjms.79.3.415

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00464-017-5472-6

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.12659/AJCR.903465

Web of Science

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12887-017-0826-8

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1089/lap.2016.0207

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Pediatric Surgeons  

<p>Reports on laparoscopic hepatectomy for malignant tumors in children are few. We present a case of pure laparoscopic partial hepatectomy for hepatoblastoma. A baby girl with Beckwith-Wiedemann syndrome underwent surgical closure of an omphalocele on the sixth day of life. At 4 months, sonographic screening revealed a liver tumor. The alpha-fetoprotein level was 23,060.69 ng/ml, and contrast-enhanced computed tomography revealed a 3.7-cm mass at the left lateral segment of the liver. A biopsy of the mass confirmed the diagnosis of hepatoblastoma (PRETEXT I). After 4 cycles of cisplatin monotherapy, the size of the tumor decreased to 2.7 cm. Laparoscopic partial hepatectomy was performed when she was 6 months old. An umbilical incision was made in an inverted Y shape, allowing for E-Z Access^TM with a Lap Protector^TM insertion through which a 1.2-cm trocar was introduced. Two 5-mm working ports were placed lateral to the rectus muscle of either side immediately superior to the umbilicus. After placing a tape around the porta hepatis for the Pringle maneuver in the case of severe bleeding, intraoperative ultrasonography was performed for the identification of the vascular tree and hepatic and portal veins, and the localization of the tumor for accurate and safe resection. Enseal^® was used to divide the hepatic parenchyma. Branched vessels and ducts were clipped and transected using Enseal^®. The surgical specimen was extracted through the umbilical incision without enlarging the incision. The patient had an uncomplicated recovery. No recurrence was observed during a 2-year follow-up.</p>

DOI： 10.11164/jjsps.53.5_1073

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.18999/nagjms.78.4.447

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ped.13040

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：株式会社医学書院  

DOI： 10.11477/mf.6003200186

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00595-016-1434-1

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

Web of Science

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-016-3973-3

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpedsurg.2016.09.017

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/jhbp.395

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-016-3939-5

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-016-3932-z

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.4103/0972-9941.182655

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.4103/0972-9941.181771

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：NAGOYA UNIV, SCH MED  

The purpose of this study is to examine the feasibility of single-incision laparoscopic percutaneous extraperitoneal closure (LPEC) for incarcerated inguinal hernia (IIH) repair. 6 single-incision LPEC procedures were performed for IIH repair and 60 procedures were performed for reducible inguinal hernia (RIH) in the same period of time in one hospital. The laparoscope and one pair of grasping forceps were placed through the same umbilical incision. In IIH repair, the herniated organ was gently pulled using the grasping forceps with external manual pressure. If it was difficult to reduce the herniated organ with one pair of forceps, another pair of forceps were inserted through a multi-channel port without extending the umbilical incidion. Using the LPEC needle, the hernia orifice was closed extraperitoneally. We performed a retrospective analysis to compare the outcomes of single-incision LPEC for IIH repair or reducible inguinal hernia. All procedures were completed by single-incision without open conversion. A multi-channel port with another pair of forceps was needed in three cases. The operation time and the length of stay were significantly longer with IIH repair than with RIH repair. There were no major complications and there was no evidence of early recurrence in any patient. In conclusion, single-incision LPEC with a multi-channel port is feasible and safe for IIH repair.

Web of Science

Scopus

Other Link： http://orcid.org/0000-0002-1818-6697

Language：Japanese   Publishing type：Research paper (scientific journal)  

Web of Science

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

We describe a simple and feasible procedure for single-incision laparoscopic repair of a pediatric epigastric hernia using a novel suture-assisting needle. A multichannel port was inserted through the umbilical vertical incision. After the orifice of the hernia was identified, a suture-assisting needle, which can hold a suture at its tip, with a 2-0 thread was pierced through the skin into one side of the rectus muscle sheath into the abdominal cavity. Next, after releasing the thread, the needle was pulled out to the subcutis and pierced through another side of the rectus muscle sheath. The needle, grasping the thread again, was subsequently pulled out through the abdominal wall outside, and the thread was tied extracorporeally. This knot was buried subcutaneously. Operative procedures of single-incision laparoscopic repair of an epigastric hernia have become simple and feasible with the use of a novel suture-assisting needle with an excellent cosmetic result.

DOI： 10.1016/j.epsc.2015.11.010

Web of Science

Scopus

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Pediatric Surgeons  

<p>Fibrolamellar hepatocellular carcinoma (FLHCC) is rare in children. In Japan, there are only six reports of children with FLHCC. We report a case of FLHCC aggressively treated by surgery and chemotherapy. A 12-year-old girl with liver tumor was admitted to our hospital for treatment. FLHCC with lymph node metastases was suspected from various imaging studies and definitively diagnosed as FLHCC by laparotomy biopsy. One cycle of gemcitabine/oxaliplatin (GEMOX) chemotherapy was administered preoperatively because of multiple lymph node metastases. After chemotherapy, her PIVKA-II level decreased but there was no reduction in tumor size. As a result, left hepatectomy and lymphadenectomy were performed. GEMOX chemotherapy was administered as a postoperative adjuvant. After 2 cycles of GEMOX chemotherapy, she developed adhesive ileus and adhesiotomy was performed. Ten cycles of GEMOX chemotherapy were administered after adhesiotomy, and then she was discharged. To date, 3 years after surgery, there is no evidence of recurrence.</p>

DOI： 10.11164/jjsps.52.6_1251

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

Patients with hepatic arteriovenous malformations rarely present with pulmonary hypertension. We report the case of a 3-month-old boy who developed severe pulmonary hypertension due to a hepatic arteriovenous malformation. The use of pulmonary vasodilators to treat the patient's pulmonary hypertension worsened his high-output heart failure. This is the first case in which emergency hepatectomy rescued a patient with hepatic arteriovenous malformations who developed pulmonary hypertension.

DOI： 10.1016/j.epsc.2015.10.017

Web of Science

Scopus

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ped.12715

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ases.12263

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1089/lap.2015.0109

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ped.12599

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：NAGOYA UNIV, SCH MED  

We report a case of accessory scrotum (AS) in the perineal region with peduncular lipoma, diagnosed prenatally. A male fetus of 31 weeks' gestation was referred to our department with a perineal mass. Prenatal ultrasonography and magnetic resonance imaging showed a mass of 1.0 x 1.2 cm located posterior to the scrotum. No other abnormalities were noted during pregnancy. The patient was delivered vaginally at 38 weeks of gestation. On physical examination, a soft peduncular mass with a rugged and pigmented swelling was located between the normally developed scrotum and the anus. There were no specific symptoms or any other associated congenital anomalies. We completely excised the mass at one month of age. A histological examination revealed lipoma, with tissue suggestive of scrotum, so a definite diagnosis of AS was made. AS is a rare congenital anomaly of the scrotum. We review the literature.

Web of Science

Scopus

Other Link： http://orcid.org/0000-0002-1818-6697

Language：English   Publishing type：Research paper (scientific journal)   Publisher：NAGOYA UNIV, SCH MED  

Femoral hernias are relatively rare in children, and more than half of pediatric femoral hernias are misdiagnosed. A 3-year-old boy was treated for an indirect inguinal hernia at the age of 2, but he exhibited an inguinal bulge one month after the operation. He underwent laparoscopy, and a right femoral hernia was detected. The femoral hernia was laparoscopically repaired via two small incisions: a 1.0-cm umbilical incision for a 3-mm 30 degrees laparoscope and 3-mm grasping forceps and a 5-mm right lateral incision for 3-mm grasping forceps. After the hernia sac had been reflected into the abdominal cavity and resected, the iliopubic tract was sutured to Cooper's ligament using a laparoscopic percutaneous extracorporeal closure (LPEC) needle and 2-0 non-absorbable sutures. Laparoscopy enables the accurate diagnosis of rare and often missed pediatric femoral hernias. Our laparoscopic technique for treating femoral hernias is easy and effective. Although these early results are encouraging, more cases involving longer follow-up periods should be accumulated to confirm the efficacy of our technique.

Web of Science

Scopus

Other Link： http://orcid.org/0000-0002-1818-6697

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpedsurg.2015.07.008

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ped.12529

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1089/lap.2014.0250

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.vaccine.2015.01.075

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.11477/mf.1413205164

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：NAGOYA UNIV, SCH MED  

Gastric duplication cyst is a rare anomaly, and most cases are recognized during childhood. Recently, several pediatric cases with small gastric duplication cysts treated by laparoscopic resection have been reported. Here, we describe an infant in whom we successfully performed laparoscopic partial gastrectomy for the treatment of a huge gastric duplication cyst. To the best of our knowledge, this is the largest gastric duplication cyst treated by laparoscopic surgery among infants. We introduce our procedure and some tips.

Web of Science

Scopus

Other Link： http://orcid.org/0000-0002-1818-6697

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.4293/JSLS.2014.00238

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3978/j.issn.2224-4336.2015.02.01

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Surgical Association  

A baby girl delivered at the gestational age of 38 week's was referred to our department because of an intraabdominal cyst diagnosed prenatally. There were no specific symptoms after birth. USG revealed a cyst-like structure with gut signature, and CT showed a cystic mass in the abdomen containing air. A preoperative diagnosis of duplication of the alimentary tract or Meckel's diverticulum was made, and a laparoendoscopic single-site surgery was performed when the baby girl was ten months old. An inverted Y-shaped incision was made at the umbilicus, and laparoscopic exploration revealed a cystic mass sharing a common wall and blood supply with the ileum on the mesenteric side. We exteriorized the duplication cyst with normal ileum from the umbilical incision, and performed resection of the segment of the small bowel including the cystic mass. Histopathology revealed that the ileal duplication cyst was lined with gastric epithelium. The postoperative course was uneventful.

DOI： 10.3919/jjsa.76.529

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1155/2015/173014

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Scopus

Other Link： http://orcid.org/0000-0002-1818-6697

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1089/lap.2014.0222

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-014-3575-x

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-014-3569-8

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00595-013-0605-6

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：NAGOYA UNIV, SCH MED  

Midgut volvulus is a highly life-threatening condition that carries a high risk of short gut syndrome. We report a case of catastrophic neonatal midgut volvulus in which second-look laparotomy revealed apparently non-viable remnant small intestine but with a moderate blood supply. Full-thickness small intestine necrosis was distributed in a patchy fashion, with non-viable and necrotic areas distributed so widely that no portion of the intestine could be resected. A section of full-thickness necrotic intestine preserved at surgery was able to regenerate, and normal function was restored over a period of 1 month. This case indicated that intestinal resumption may be dependent on blood flow. Even when intestinal viability is questionable, preservation enables the chance of regeneration if moderate blood flow is present.

Web of Science

Scopus

Other Link： http://orcid.org/0000-0002-1818-6697

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：一般社団法人日本外科学会  

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society of Pediatric Surgeons  

High-output heart failure in a neonate due to pulmonary sequestration is rare. We report a case of neonatal heart failure relieved with thoracoscopic resection of an intralobar pulmonary sequestration. A male neonate of 39-week gestational age presented with respiratory distress, chest X-ray and echocardiography revealed high-output heart failure. A computed tomography showed a left lower pulmonary sequestration with venous drainage into the azygos system. Preoperative diagnosis is an extralobar pulmonary sequestration, and high-output heart failure is caused by arteriovenous shunt in the pulmonary sequestration. We intervened with thoracoscopic resection on day-of-life 21. Intraoperative diagnosis is an intralobar pulmonary sequestration. Postoperative course was uneventful, and the patient was discharged on postoperative day 20 without any sign of heart failure.

DOI： 10.11164/jjsps.50.5_946

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1089/lap.2013.0180

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1089/lap.2013.0127

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpedsurg.2013.08.010

Web of Science

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-013-3383-8

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-013-3373-x

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1089/lap.2013.0110

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00595-012-0426-z

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1089/lap.2013.0130

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/j.1442-200X.2012.03663.x

Web of Science

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpedsurg.2012.08.028

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： doi: 10.1111/j.1442-200X.2012.03663.x.

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

Pediatric patients with large extraovarian teratomas with a significant solid component are usually treated using open surgery because the size of the intracorporeal cavity does not facilitate the manipulation of large tumors. Here, we describe the cases of 3 children who underwent minimally invasive surgery for large extraovarian teratomas (diameter &gt
10 cm), including 2 cases of retroperitoneal teratoma and 1 case of a thoracic teratoma. All tumors had a large amount of sebaceous material that displaced other surrounding organs. Tumor volumes were reduced by intraoperative needle aspiration using a SAND balloon catheter with a double balloon that is designed to minimize the risk of spillage. Intraoperative needle aspiration of cystic content can provide sufficient working space and facilitates safe separation of the major vessels from the tumor. Treatment of large extraovarian teratomas by minimally invasive surgery involving skin incisions that result in a less noticeable scar, such as a Pfannenstiel incision or axillary incision, can achieve improved cosmetic outcomes. © 2013 The Authors.

DOI： 10.1016/j.epsc.2013.07.003

Scopus

Other Link： http://orcid.org/0000-0002-1818-6697

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本小児血液・がん学会  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-012-3146-y

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00383-011-3008-z

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.7_1078_3

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_400_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_399_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_445_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_443_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_443_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_539_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_668_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_596_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_585_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.3_505_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.48.1_143_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：埼玉県医学会  

腹腔鏡下腎摘除術を施行した小児患者16例(男児4例、女児12例、中央値5歳)の成績を報告した。男児の基礎疾患はそれぞれ精嚢腺嚢胞と同側単純性尿管瘤合併、膀胱尿管逆流症と腎盂尿管移行部狭窄合併、単純性尿管瘤とMCDK合併、尿管異所開口であった。女児は全例尿管異所開口で、9例は開口部が同定不能であった。手術は患側を上にした半側臥位とし、3ポート或いは4ポートで行った。経腹腔的に腎に到達し、腎周囲を電気メス、超音波凝固切開装置を用いて剥離した。尿管と腎茎部の血管はエンドループ或いはクリップを用いて切離し、臍の創より腎臓を摘出した。手術時間は中央値120分、麻酔時間217分、出血量0mlで、術中合併症はなかった。術後在院日数は中央値5.5日で、精嚢腺嚢胞切除を併施した1例に術後尿閉を認め、一時的な間歇導尿を要したが自然に軽快した。病理組織学的にはhypoplastickidnyが多く、一部にrenal dysplasiaを伴うものも認めた。

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

1歳4ヵ月男児。出生時より右陰嚢が鼠径部に認められ、産院で異所性陰嚢と診断後、著者らの施設へ紹介来院となった。初診時、陰嚢右側は本来の位置から離れ右鼠径部にあり、内部には精巣が存在していた。一方、陰嚢左側と左精巣は正常の位置に存在しており、陰嚢正中に縫線が認められた。また他の体表奇形はみられず、腹部エコーでも泌尿生殖器系の異常は認められなかった。そこで、1歳4ヵ月目に手術が施行され、手術はZ形成術により右鼠径部の陰嚢を本来の位置に移動させた。その結果、合併症は認めず、術後5日目で退院となり、更に術後1ヵ月経過では右陰嚢の色調良好が確認された。尚、右精巣にも萎縮性変化は認められなかった。

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpedsurg.2010.09.097

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本腹部救急医学会  

腹腔鏡手術は低侵襲で整容的に優れるため,腹部救急疾患に対しても適応が拡大しつつある。当科では最近12年間に,急性虫垂炎・肥厚性幽門狭窄症を除く小児腹部救急疾患75例に対し腹腔鏡手術を行った。診断は腸閉塞17例,脳室腹腔シャント障害9例,卵巣・卵管捻転8例,Meckel憩室(腸閉塞を除く),横隔膜ヘルニア各7例等であった。診断確定目的の腹腔鏡を21例に行い6例は観察のみで終了した。新生児例は捻転のない腸回転異常症と卵巣嚢腫捻転の計3例であった。術中小腸損傷は2例(2.5%),開腹移行は4例(5.0%)あった。腹部救急疾患に対して腹腔鏡手術を行うには,迅速な開腹移行にも対応できる,チームとしての熟練が必要である。腹腔鏡手術の絶対的禁忌は全身麻酔・気腹のハイリスク例であり,相対的禁忌として腸管壊死を伴う絞扼性イレウスがあげられるが,その他の症例では腹腔鏡手術の適応を考慮できると考えられた。(著者抄録)

DOI： 10.11231/jaem.31.31

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_516_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.3_375_4

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.2_298_4

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.3_376_5

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_582_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_588_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_715_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_732_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_741_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_751_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_755_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_610_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_490_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.6_929_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_560_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_565_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_567_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_568_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.4_568_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.1_182_3

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.1_167_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.1_168_3

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.1_168_4

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.1_173_3

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.1_175_3

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.3_377_4

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.47.7_1094_2

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpedsurg.2010.08.037

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：埼玉県医学会  

2000年1月〜2009年12月に胸腔鏡補助下(VATS)12例および完全胸腔鏡下(CTL)肺葉切除3例について、手術成績・合併症などを後方視的に検討した。VATSとCTLにおける中央値はそれぞれ、手術時年齢5歳10ヵ月・1歳3ヵ月、手術時体重は17.8kg・9.5kg、手術時間は184分・222分、出血量は116g・28g、術後在院日数は8.5日・6日であった。VATSで1例が出血のため開胸移行したが、いずれも術後合併症は認めなかった。

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

2005年以降に腹腔鏡補助下肛門形成術(LAARP)を施行した28症例(男児22例、女児6例、手術時平均月齢6.5±3.1ヵ月)を対象に術式の問題点および術後の排便機能について後方視的に検討した。その結果、平均手術時間は194±61分、出血量は7.8±8.4mlで、早期合併症としては直腸肛門縫合不全が3例にみられ、1例は保存的に軽快、2例は再吻合を要した。晩期合併症としては大きな尿道後部嚢胞が3例にみられ、うち2例は嚢胞摘出標本に直腸粘膜がみられたことから、瘻孔切離部が直腸側に寄りすぎたため遺残瘻孔となり、徐々に増大したと考えられた。術後1年以上経過時に施行のMRIでは1.5cm以下の嚢胞が6例に認められたが、それらは2年以上経過しても増大傾向はみられなかった。排便機能は4歳時では1日おきに浣腸を行っている症例が多くみられたが、失禁はほとんどみられず時に汚染がみられる症例が多かった。7・8歳時では4歳時と比べ各項目で徐々に改善がみられ、便意と総合点では有意な改善が認められた。尚、肛門静止圧・肛門管長・直腸肛門弛緩反射についてはPSARPと差は認められなかった。

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jpedsurg.2010.03.013

PubMed

Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Choledochal cyst causes liver fibrosis, the extent of which varies with each case. Liver damage seldom progresses to cirrhosis, but when it does, it is generally irreversible. We report an infantile case of liver cirrhosis associated with choledochal cyst in which complete clinical resolution was achieved by surgery. Pancytopenia caused by splenomegaly, massive ascites, hypoalbuminemia, and coagulation abnormality that were observed during the early postoperative period had disappeared within 4 months after surgery. Needle liver biopsy performed at 1 year after surgery revealed marked improvement in liver fibrosis. (C) 2010 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jpedsurg.2010.01.030

Web of Science

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本小児外科学会  

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01113&link_issn=&doc_id=20100602240204&doc_link_id=10.11164%2Fjjsps.46.3_524_2&url=https%3A%2F%2Fdoi.org%2F10.11164%2Fjjsps.46.3_524_2&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.6_911_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.3_701_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.3_520_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.3_524_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.3_550_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.3_560_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.1_136_1

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.6_1011_3

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.6_1004_2

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.6_995_4

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.6_1014_4

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.4_800_3

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：特定非営利活動法人 日本小児外科学会  

DOI： 10.11164/jjsps.46.4_820_4

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(NPO)日本小児がん学会  

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)東京医学社  

1999〜2008年の10年間に著者等の施設における2500g未満の低出生体重児で外科手術を行った124症例(男児71例、女児53例)を対象に、出生体重・在胎週数・診断・予後について後方視的に検討した。その結果、平均在胎週数は34(21〜41)週、出生体重は平均1817(506〜2486)gで、出生体重の内訳は1000g未満の超低出生体重児25例、1000g以上1500g未満の極低出生体重児10例、1500g以上2500g未満の低出生体重児89例であった。疾病別では腸閉鎖・狭窄22例、消化管穿孔21例、直腸肛門奇形20例、食道閉鎖症16例、腸回転異常症8例、壊死性腸炎7例、臍帯ヘルニア6例、腹壁破裂5例、肥厚性幽門狭窄症4例、横隔膜ヘルニア・ヒルシュスプルング病・胆道閉鎖症各2例であった。出生前診断は124例中14例(11.2%)で、全国集計の26.7%より胎児診断率が低かった。予後では術後死亡率は13%(16例)で全国集計の16.2%と同等であった。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

We report 2 cases of growth spurt-related recurrence after Nuss procedure. Each of the 2 cases underwent bar insertion at the age of 6 and I I years, respectively. The support bar was removed 2 years later followed by severe redepression during the growth spurt. One patient underwent redo Nuss procedure elsewhere. The other patient was diagnosed as idiopathic precocious puberty and is in treatment. The possibility of growth spurt-related recurrence must be explained to those who undergo early correction before surgery, and follow-up is mandatory at least until patients&apos; puberty is over. (C) 2009 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jpedsurg.2009.04.014

Web of Science

PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本膵・胆管合流異常研究会