Faculty Profiles - UCHIDA Hiroo

Single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) for inguinal hernia with prolapsed ovary. Reviewed

Urinary Biomarkers Predicting Treatment Outcomes in Neuroblastoma Reviewed

Atsushi Narita, Akinari Hinoki, Kazuki Yokota, Motoharu Hamada, Shinsuke Kataoka, Nozomu Kawashima, Hideki Muramatsu, Nobuhiro Nishio, Hiroo Uchida, Yoshiyuki Takahashi

PEDIATRIC BLOOD & CANCER Vol. 68 2021.11

Shirota C, Tainaka T, Sumida W, Yokota K, Makita S, Amano H, Okamoto M, Takimoto A, Yasui A, Nakagawa Y, Hinoki A, Uchida H

Surgical endoscopy 2021.10

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

Factors associated with bleeding after endoscopic variceal ligation in children Reviewed

Yokoyama Shinya, Ishizu Yoji, Ishigami Masatoshi, Honda Takashi, Kuzuya Teiji, Ito Takanori, Hinoki Akinari, Sumida Wataru, Shirota Chiyoe, Tainaka Takahisa, Makita Satoshi, Yokota Kazuki, Uchida Hiroo, Fujishiro Mitsuhiro

PEDIATRICS INTERNATIONAL Vol. 63 ( 10 ) page： 1223 - 1229 2021.10

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

Late postoperative complications of congenital biliary dilatation in pediatric patients: a single-center experience of managing complications for over 20 years Reviewed

SERUM MATRIX METALLOPROTEINASE-7 IN JAPANESE INFANTS WITH BILIARY ATRESIA Reviewed

Hiroo UCHIDA

Hepatology Vol. 74 page： 1178A - 1178A 2021.10

Amano Hizuru, Shirota Chiyoe, Tainaka Takahisa, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Takimoto Aitaro, Tanaka Yujiro, Hinoki Akinari, Kawashima Hiroki, Uchida Hiroo

SURGERY TODAY Vol. 51 ( 9 ) page： 1488 - 1495 2021.9

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

An imaging study on tracheomalacia in infants with esophageal atresia: the degree of tracheal compression by the brachiocephalic artery is a good indicator for therapeutic intervention Reviewed

血清MMP-7は胆道閉鎖症の肝移植予測マーカーとなりうるか? Reviewed

安田亮輔, 坂口廣高, 深堀優, 吉丸耕一朗, 松浦俊治, 眞田幸弘, 藤代準, 田井中貴久, 内田広夫, 佐々木英之, 仁尾正記, 水落建輝

日本小児栄養消化器肝臓学会雑誌 Vol. 35 ( Suppl. ) page： 106 - 106 2021.9

Sumida Wataru, Tainaka Takahisa, Shirota Chiyoe, Yokota Kazuki, Makita Satoshi, Takimoto Aitaro, Yasui Akihiro, Okamoto Masamune, Nakagawa Yoichi, Hinoki Akinari, Uchida Hiroo

PEDIATRIC SURGERY INTERNATIONAL 2021.8

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

Urinary N-1,N-12-diacetylspermine as a biomarker for pediatric cancer: a case-control study Reviewed

Yokota Kazuki, Hinoki Akinari, Hiramatsu Kyoko, Amano Hizuru, Kawamura Machiko, Kuwatsuka Yachiyo, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Makita Satoshi, Okamoto Masamune, Takimoto Aitaro, Yasui Akihiro, Nakagawa Yoichi, Uchida Hiroo, Kawakita Masao

PEDIATRIC SURGERY INTERNATIONAL 2021.8

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

Comparative study of open and laparoscopic Kasai portoenterostomy in children undergoing living donor liver transplantation for biliary atresia Reviewed

Takeda Masahiro, Sakamoto Seisuke, Uchida Hajime, Shimizu Seiichi, Yanagi Yusuke, Fukuda Akinari, Uchida Hiroo, Yamataka Atsuyuki, Kasahara Mureo

PEDIATRIC SURGERY INTERNATIONAL 2021.8

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

Current thoracoscopic approach for mediastinal neuroblastoma in Japan-results from nationwide multicenter survey Reviewed

Kawano Takafumi, Souzaki Ryota, Sumida Wataru, Shimojima Naoki, Hishiki Tomoro, Kinoshita Yoshiaki, Uchida Hiroo, Tajiri Tatsuro, Yoneda Akihiro, Oue Takaharu, Kuroda Tatsuo, Hirobe Seiichi, Koshinaga Tsugumichi, Hiyama Eiso, Nio Masaki, Inomata Yukihiro, Taguchi Tomoaki, Ieiri Satoshi

PEDIATRIC SURGERY INTERNATIONAL 2021.8

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

Clinical characteristics and outcomes of the right congenital diaphragmatic hernia compared to the left: a 10-year single-center experience Reviewed

Okamoto Masamune, Amano Hizuru, Uchida Hiroo, Hinoki Akinari, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Yokota Kazuki, Makita Satoshi, Takimoto Aitaro, Yasui Akihiro, Nakagawa Yoichi

PEDIATRIC SURGERY INTERNATIONAL 2021.8

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

Double common bile duct associated with pancreaticobiliary maljunction Reviewed

Yamada Kenta, Ishikawa Takuya, Ohno Eizaburo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Yashika Jun, Yoshikawa Masakatsu, Takami Hideki, Inokawa Yoshikuni, Uchida Hiroo, Kawashima Hiroki, Fujishiro Mitsuhiro

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 83 ( 3 ) page： 655 - 661 2021.8

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

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日本小児外科学会小児外科卒前教育アンケート調査 2019 Reviewed

大植孝治, 内田広夫, 石丸哲也, 井上幹大, 大竹耕平, 神山雅史, 五藤周, 永田公二, 中原さおり, 奈良啓悟, 矢内俊裕, 令和2、3年度日本小児外科学会教育委員会

日本小児外科学会雑誌 Vol. 57 ( 5 ) page： 884 - 888 2021.8

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

小児外科卒前教育の現況と問題点について検討した。全国の医育機関(大学医学部、医学系大学)82施設の医学部長医学系大学長宛にアンケート調査用紙を郵送し、73施設(89%)から回答を得た。小児外科診療部門は70施設(96%)に存在しており、卒前教育を担当する部署が97%の施設にあり、以前より多くなっていた。小児外科の講義はすべての医育機関で行われており、6年間で中央値6時間と比較的多くの時間を費やして講義が行われていた。また、施設内で臨床実習を行っている64施設(89%)のうち小児外科単独で行っているのは32施設(50%)であり、施設内・外を含めて臨床実習が行われていない施設が5施設あり、3施設には専門医がいなかった。施設外で臨床実習を行っていない39施設のうち、12施設が他施設での臨床実習を希望していた。特に関東の施設で他施設実習の希望が多く認められた。

Development of a novel diagnostic system for bile duct cancer using urinary metabolites. Reviewed

Amano Hizuru, Hinoki Akinari, Uchida Hiroo, Yokota Kazuki, Ishigaki Takashi, Sakairi Minoru, Abe Mayumi, Terui Yasushi, Oda Hirohisa, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Makita Satoshi, Takimoto Aitaro, Okamoto Masamune, Yasui Akihiro, Nakagawa Yoichi

CANCER RESEARCH Vol. 81 ( 13 ) 2021.7

A patient with very early onset FH-deficient renal cell carcinoma diagnosed at age seven Reviewed

Taniguchi Rieko, Muramatsu Hideki, Okuno Yusuke, Yoshida Taro, Wakamatsu Manabu, Hamada Motoharu, Shirota Chiyoe, Sumida Wataru, Hinoki Akinari, Tainaka Takahisa, Gotoh Yoshimitsu, Tsuzuki Toyonori, Tanaka Yukichi, Kojima Seiji, Uchida Hiroo, Takahashi Yoshiyuki

FAMILIAL CANCER 2021.6

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