研究者詳細 - 城田　千代栄

論文 - 城田　千代栄

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Response to the Comment on "Long-Term Outcomes of Congenital Biliary Dilatation Surgery: A Single-Center Study Highlighting the High Incidence of Complications Within 5 Years"

Maeda, T; Uchida, H; Shirota, C

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2026年1月

Hyponatremia after pediatric surgery: Randomized trial of fluid composition on antidiuretic hormone response Open Access

Yokota, K; Uchida, H; Manaka, K; Nangaku, M; Kuwatsuka, Y; Ando, M; Nishiwaki, K; Hirai, T; Tainaka, T; Shirota, C; Sumida, W; Makita, S; Amano, H; Hinoki, A

PEDIATRIC RESEARCH 99 巻 ( 1 ) 頁： 263 - 269 2026年1月

記述言語：英語出版者・発行元：Pediatric Research

Background: We examined the underlying mechanisms of whether hyponatremia could be induced by hypotonic solution administration after the postoperative invasive phase (POIP). Methods: We included patients who had undergone surgery with expected oral feeding resumption after postoperative day (POD) 3. In this open-label, randomized controlled trial, 100 patients were assigned to three groups by sodium concentrations ([Na]) used for maintenance infusions: 136 mEq/L (ISO) (n = 34), 68 mEq/L (HYPO) (n = 33), and 34 mEq/L (exHYPO) (n = 33). Potassium (20 mEq/L) and glucose (60 g/L) were added to each infusion. Ringer’s solution was used in all groups for the first 12 h postoperatively, then switched to a maintenance solution. Blood samples were drawn and evaluated on POD 3. Results: Hyponatremia frequencies on POD 3 were 3.6, 18, and 39% in the ISO, HYPO, and exHYPO groups, respectively, with a significant difference between the ISO and exHYPO groups. Additionally, 90% of the patients still had excessive antidiuretic hormone (ADH) secretion on POD 3. There were no remarkable adverse events. Conclusion: The persistence of surgical stress-induced ADH secretion until POD 3 suggested that hyponatremia was induced by exHYPO administration. However, using Ringer’s solution during the POIP might prevent hyponatremia in HYPO patients. Registration number: UMIN000029057 (https://www.umin.ac.jp/ctr/index.htm). Date of first registration: 01/11/2017 Impact: After the postoperative invasive phase, non-osmotic antidiuretic hormone (ADH) secretion due to surgical stress persisted, resulting in an excess ADH state for at least 3 postoperative days (PODs). Administration of extremely hypotonic electrolyte infusions under such circumstances might induce hyponatremia. Adequate extracellular fluid administration during the invasive phase after major pediatric laparoscopic surgery did not cause further increases in ADH secretion or hyponatremia, even for HYPO maintenance fluid.

DOI： 10.1038/s41390-025-04124-8

Strategy of reduced port gastrostomy as a safe procedure for paediatric patients Open Access

Gohda, Y; Uchida, H; Tainaka, T; Sumida, W; Shirota, C; Makita, S; Satomi, M; Yasui, A; Kato, D; Maeda, T; Ishii, H; Ota, K; Guo, YH; Liu, JH; Hinoki, A

JOURNAL OF MINIMAL ACCESS SURGERY 22 巻 ( 1 ) 頁： 22 - 26 2026年1月

記述言語：英語出版者・発行元：Journal of Minimal Access Surgery

Background: Laparoscopic gastrostomy has improved surgical and cosmetic outcomes. Our approach involves a strategy of reduced port surgery, wherein only the umbilicus and tube insertion site were incised, with an additional port inserted if manipulation is difficult. This study aimed to investigate the outcomes of our reduced port gastrostomy strategy. Patients and Methods: The paediatric patients who underwent gastrostomy at our institution from July 2013 to March 2023 were reviewed retrospectively. Surgical outcomes were compared between patients who underwent reduced port gastrostomy and those who underwent multiport gastrostomy with or without fundoplication. Results: Of the 78 patients who underwent gastrostomy, 25 and 39 patients who underwent reduced port gastrostomy and multiport gastrostomy with or without fundoplication, respectively, were included. Five patients who underwent reduced port gastrostomy required an additional port. The operative time during gastrostomy was shorter in the multiport gastrostomy group (21.3 min vs. 17.2 min, P = 0.00). One splenic injury in the reduced port gastrostomy group and one split of the stomach in the multiport gastrostomy group occurred and were completely repaired intraoperatively. No patient required reoperation within 30 days after gastrostomy. Post-operative complications, such as infection with pus (1 vs. 2, P = 1.00), external leakage requiring nutritional management change or tube replacement (2 vs. 2, P = 0.64) and tube dislodgement (1 vs. 0, P = 0.39), were similar between the two groups. Conclusions: The strategy of reduced port gastrostomy was safe and cosmetically favourable compared with multiport gastrostomy.

DOI： 10.4103/jmas.jmas_218_24

Development of an AI-based system for vagus nerve recognition during thoracoscopic esophageal atresia repair: Based on the comparison with pediatric surgeon Open Access

Yasui A., Hayashi Y., Hinoki A., Amano H., Shirota C., Tainaka T., Makita S., Takimoto A., Mori K., Uchida H.

Asian Journal of Surgery 2026年

出版者・発行元：Asian Journal of Surgery

Background/objective: This study aimed to develop an artificial intelligence (AI) model for recognizing the vagus nerve in thoracoscopic esophageal atresia (EA) surgery and conduct a comparative study with pediatric surgeons to demonstrate its potential practical utility. Methods: We established a training dataset by annotating images from thoracoscopic EA surgery. Using this dataset, we developed an AI model to automatically recognize the vagus nerve. The Dice coefficient was used as the objective metrics following four-fold cross-validation. We included 54 pediatric surgeons in the comparative study. Based on clinical experience, pediatric surgeons were categorized into 10 experts and 44 novices. We compared the speed of vagus nerve recognition between the AI model and surgeons using 14 test videos created from EA cases not included in the training dataset. Subsequently, participants rated the accuracy and utility of the AI model using a five-point Likert scale. Results: We annotated 9514 images extracted from 36 cases and used them as training data. The mean Dice coefficient of the vagus nerve was 0.501. The AI model recognized the vagus nerve significantly faster than the Novice group (median: 252 frames, interquartile range [IQR]: 129–538] vs. 661 frames, IQR: 340–1229; p = 0.001), with no significant difference with the Expert group (252 frames, IQR: 129–538 vs. 419 frames, IQR 242–827; p = 0.159). Regarding recognition accuracy, the experts gave a high average rating of 4.5 points. Conclusion: We have developed an AI model for vagus nerve recognition with potentially comparable accuracy to expert pediatric surgeons.

DOI： 10.1016/j.asjsur.2026.01.004

One-stage minimally invasive surgery is as safe and feasible as two-stage surgery for perforated choledochal cyst in pediatric patients who are hemodynamically stable

Tainaka, T; Shirota, C; Makita, S; Amano, H; Kano, Y; Yasui, A; Nakagawa, Y; Kato, D; Maeda, T; Ishii, H; Murata, Y; Utsunomiya, A; Hinoki, A; Uchida, H

SURGERY TODAY 2025年12月

記述言語：英語出版者・発行元：Surgery Today

To contribute to the evolving evidence guiding the optimal management of perforated choledochal cyst (PCC), a rare but serious complication of choledochal cyst. We reviewed data from 10 patients with PCC treated at our institution between 2004 and 2024. The patients were categorized into a two-stage (n = 5) group and a one-stage group (n = 5). Surgical outcomes, postoperative complications, and length of hospital stay were compared. The operative time was significantly longer in the one-stage group than in the two-stage group (353 min vs. 282 min, respectively; p = 0.006), whereas blood loss was comparable between the groups. Open surgery was more frequent in the two-stage group than the one-stage group (80% vs. 0%; p = 0.048). Early complications occurred in 40% and 20% of the patients in the two-stage and one-stage groups, respectively (p = 1.000). Anastomotic leakage occurred in one patient from each group. The hospital stay was significantly longer in the two-stage group than in the one-stage group. The late complication incidence did not differ significantly between the groups. Our findings suggest that one-stage surgery is a safe and effective option for PCC in patients who are clinically stable and when performed by experienced surgeons. These findings may assist in the management of PCC.

DOI： 10.1007/s00595-025-03203-x

Comparison of Postoperative Outcomes of Open, Laparoscopic, and Robotic Surgery for Pediatric Choledochal Cyst Excision

Maeda, T; Uchida, H; Shirota, C; Tainaka, T; Makita, S; Yasui, A; Kato, D; Ishii, H; Asai, H; Utsunomiya, A

JOURNAL OF PEDIATRIC SURGERY 60 巻 ( 12 ) 頁： 162642 2025年12月

記述言語：英語出版者・発行元：Journal of Pediatric Surgery

Background: Choledochal cyst is treated with extrahepatic bile duct resection and hepaticojejunostomy. Minimally invasive approaches, including laparoscopic surgery (LS) and robotic surgery (RS), offer potential advantages over open surgery (OS), but their impact on perioperative and short-term postoperative outcomes remains unclear. Methods: This retrospective study analyzed 201 pediatric patients who underwent OS (n = 83), LS (n = 89), or RS (n = 29). OS was performed from 2004 to 2013, LS from 2013, and RS from 2021. Perioperative outcomes and early postoperative complications within one year were analyzed. Results: RS resulted in significantly lower blood loss (median 1.6 [IQR 0.86–2.71] mL/kg) than OS (7.0 [IQR 3.88–9.70] mL/kg) (p < 0.05). Time to oral intake was shortest in RS (median 3 [IQR 3–4] days) compared with LS and OS (both 4 [IQR 4–5] days) (p < 0.05). Drain removal occurred earlier in RS (median 5 [IQR 5–6] days) than in LS (6 [IQR 6–8] days) and OS (6 [IQR 6–7] days) (p < 0.05). Hospital stay was shorter with RS (median 7 [IQR 7–9] days) than with LS (10 [IQR 8–13] days) or OS (11 [IQR 10–14] days) (p < 0.05). Operative time was shorter for OS (median 273 [IQR 240–321] min) than LS (396 [IQR 334–453] min) or RS (388 [IQR 345–530] min) (p < 0.05). Median follow-up was 1 year (range, 1–3) for RS, 6 years (1–11) for LS, and 15 years (11–20) for OS. No significant differences were found in hepatolithiasis, anastomotic stricture, or cholangitis within the first postoperative year. Conclusion: RS demonstrated superior short-term outcomes, including reduced blood loss, faster recovery, and shorter hospitalization, suggesting lower invasiveness. Further studies with larger cohorts and extended follow-up are needed to evaluate long-term prognosis. Level of evidence: Ⅲ

DOI： 10.1016/j.jpedsurg.2025.162642

Long-Term Outcomes of Congenital Biliary Dilatation Surgery: A Single-Center Study Highlighting the High Incidence of Complications Within 5 Years Open Access

Maeda, T; Uchida, H; Shirota, C; Tainaka, T; Makita, S; Asai, H; Utsunomiya, A; Murata, Y; Guo, YH; Liu, JH

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 32 巻 ( 12 ) 頁： 901 - 909 2025年12月

記述言語：英語出版者・発行元：Journal of Hepato Biliary Pancreatic Sciences

Background: Congenital biliary dilatation (CBD) is a rare anomaly often treated surgically, yet postoperative complications remain a concern. This study aimed to evaluate the incidence, timing, and risk factors of such complications after CBD surgery. Methods: A retrospective review was conducted on 184 patients with CBD who underwent either open or laparoscopic surgery, with a mean follow-up of 9 years. The analysis focused on postoperative complications, including bile duct–related issues, pancreatic complications, and bowel obstruction. Results: Complications occurred in 14.7% of patients, predominantly bile duct–related (11.4%), followed by pancreatic (1.6%) and bowel obstruction (1.6%). Most bile duct complications, including anastomotic and intrahepatic strictures, emerged within 5 years postoperatively. Residual bile ducts were more common after open surgery, but no significant difference in other complications was observed between surgical approaches. No biliary malignancies developed during follow-up. Conclusion: The majority of complications occurred within 5 years after surgery, underscoring the importance of intensive monitoring during this period. Regular imaging and blood tests are essential for early detection. Although no malignancies were observed, long-term follow-up remains critical to address late-onset risks. Trial Registration: Clinical registration number: 2023-045432262.

DOI： 10.1002/jhbp.70011

特集総排泄腔遺残症小腸グラフトを使用した内視鏡的腟形成術

加藤大幾, 内田広夫, 城田千代栄, 田井中貴久, 牧田智, 小川雄大, 岡本眞宗, 滝本愛太朗, 安井昭洋, 高田瞬也, 林海斗, 中川洋一, 石井宏樹, 浅井一, 太田和樹

小児外科 57 巻 ( 11 ) 頁： 1192 - 1195 2025年11月

Cystathionine as a Potential Urinary Marker for Diagnosing and Assessing Pretreatment Risk in Neuroblastoma Open Access

Amano, H; Hayashi, Y; Harada, K; Narita, A; Fumino, S; Yamada, Y; Karakawa, S; Sakairi, M; Shirota, C; Tainaka, T; Yokota, K; Makita, S; Kato, D; Ishii, H; Deie, K; Mori, M; Mitani, Y; Tomioka, Y; Taguri, M; Koh, K; Tajiri, T; Kato, M; Matsumoto, K; Takahashi, Y; Iehara, T; Hinoki, A; Uchida, H

CANCER SCIENCE 116 巻 ( 11 ) 頁： 3102 - 3112 2025年11月

記述言語：英語出版者・発行元：Cancer Science

Urinary homovanillic acid (HVA) and vanillylmandelic acid (VMA) are widely used diagnostic markers for neuroblastoma, but urinary markers for risk assessment prior to invasive biopsy are lacking. We hypothesized that cystathionine (CTN) may be a new neuroblastoma biomarker and evaluated its utility for diagnosis and pretreatment risk assessment. 80 participants provided 202 urine samples: 32 from 32 control participants, 29 from 29 patients with primary neuroblastoma, and 141 from 30 patients with residual tumors, 11 of whom had primary neuroblastoma. Urinary CTN and HVA/VMA concentrations were measured using liquid chromatography/mass spectrometry. The area under the receiver operating characteristic curve (ROC-AUC) was used to evaluate diagnostic and pretreatment risk assessment performance according to the International Neuroblastoma Risk Group (INRG) pretreatment risk classification and the revised 2021 Children's Oncology Group (COG) neuroblastoma risk classification. Associations with prognostic factors were also evaluated. The AUC values for diagnosis were 0.920, 0.903, and 0.946 for HVA, VMA, and CTN, respectively. For pretreatment risk assessment (high-risk versus intermediate- and low-risk, and high- and intermediate-risk versus low-risk) the AUCs according to the INRG classification were 0.576 and 0.578 for HVA, 0.524 and 0.513 for VMA, and 0.852 and 0.708 for CTN, respectively, whereas they were 0.530 and 0.741 for HVA, 0.510 and 0.796 for VMA, and 0.758 and 0.981 for CTN, respectively, according to the COG classification. The values for MYCN status were 0.844 for HVA, 0.844 for VMA, and 0.942 for CTN. CTN may be a useful urinary marker for neuroblastoma diagnosis and pretreatment risk assessment.

DOI： 10.1111/cas.70169

Preoperative classification based on intrahepatic bile duct morphology for predicting postoperative complications in congenital biliary dilatation Open Access

Kato, D; Uchida, H; Shirota, C; Tainaka, T; Makita, S; Yasui, A; Nakagawa, Y; Maeda, T; Ishii, H; Amano, H; Hinoki, A

SURGERY 186 巻頁： 109596 2025年10月

記述言語：英語出版者・発行元：Surgery United States

Background: Late postoperative complications of congenital biliary dilatation include intrahepatic bile duct stones, cholangitis, and cholangiocarcinoma. This study aimed to establish a preoperative classification system using intrahepatic bile duct morphology and evaluate its effectiveness in predicting postoperative complications. Methods: This retrospective study reviewed 196 patients who underwent radical congenital biliary dilatation surgery between 2003 and 2022. Patients were classified into 3 risk groups based on preoperative cholangiopancreatography findings of intrahepatic bile duct morphology: risk type–low, no intrahepatic bile duct dilatation; risk type–intermediate, intrahepatic bile duct dilatation without downstream bile duct stenosis, but including stenosis at the hilar region; risk type–high, intrahepatic bile duct dilatation with downstream bile duct stenosis, including stenosis at the hilar region and more peripherally than the secondary branches. Results: The incidence of intrahepatic bile duct stones was significantly higher in risk type–high (n = 9, 53%) (P < .001) compared with risk type–low (0%) and risk type–intermediate (n = 3, 2.8%). The incidence of cholangitis was significantly higher in risk type–high (n = 9, 53%) (P < .001) compared with risk type–low (n = 3, 4.3%) and risk type–intermediate (n = 3, 2.8%). No cases of cholangiocarcinoma were observed. Patients with risk type–high who did not improve with double-balloon endoscopic retrograde cholangiography required percutaneous transhepatic biliary drainage or hepatectomy. Conclusions: Our newly proposed preoperative classification system is effective in predicting postoperative complications in congenital biliary dilatation patients. Patients classified as risk type–high require careful postoperative follow-up, particularly when intraoperative bile ductoplasty fails to relieve stenosis. Identifying high-risk cases preoperatively may help improve long-term surgical outcomes.

DOI： 10.1016/j.surg.2025.109596

Safety and efficacy of robot-assisted bile ductoplasty and intrapancreatic bile duct resection in congenital biliary dilatation: a single-center retrospective cohort (2013-2024) Open Access

Kato, D; Shirota, C; Uchida, H; Hinoki, A; Makita, S; Ogawa, K; Okamoto, M; Yasui, A; Takada, S; Hayashi, K; Nakagawa, Y; Ishii, H; Asai, H; Amano, H; Tainaka, T

JOURNAL OF ROBOTIC SURGERY 19 巻 ( 1 ) 頁： 618 2025年9月

記述言語：英語出版者・発行元：Journal of Robotic Surgery

Robot-assisted surgery is increasingly being utilized for congenital biliary dilatation (CBD); however, limited data exist on its feasibility across age groups, particularly for bile ductoplasty and intrapancreatic bile duct (IPBD) resection. This was a retrospective cohort study that compared the outcomes of robot-assisted versus laparoscopic CBD surgery in 159 patients (Rob group: 57; Lap group: 102) treated between 2013 and 2024. In the Rob group, hospital stay was significantly shorter, enteral feeding was started earlier, and drain duration was reduced, especially in pediatric patients. Late complications (e.g., cholangitis) were significantly less common in the Rob group compared to the Lap group (3.5 vs. 18%). The length of residual IPBD was similar in both groups. Furthermore, robotic procedures facilitate a secure and accurate hilar bile ductoplasty, thereby contributing to favorable outcomes without anastomotic stenosis or hepatolithiasis. While these findings support the potential advantages of robot-assisted CBD surgery, the follow-up period was significantly shorter in the Rob group than in the Lap group, and thus definitive conclusions regarding long-term outcomes cannot yet be drawn. Robot-assisted surgery appears safe and is associated with faster short-term recovery; long-term comparative effectiveness requires longer follow-up and adjusted analyses.

DOI： 10.1007/s11701-025-02782-8

First Report of Single-Surgeon Single-Incision Laparoscopic Percutaneous Extraperitoneal Closure Using the Senhance Robotic System as Camera Holder for Pediatric Inguinal Hernia Open Access

Kato, D; Tainaka, T; Shirota, C; Makita, S; Ogawa, K; Okamoto, M; Yasui, A; Takada, S; Hayashi, K; Nakagawa, Y; Ishii, H; Asai, H; Utsunomiya, A; Hinoki, A; Nagata, N; Uchida, H

ASIAN JOURNAL OF ENDOSCOPIC SURGERY 18 巻 ( 1 ) 頁： e70131 2025年8月

記述言語：英語出版者・発行元：Asian Journal of Endoscopic Surgery

Single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) is used for pediatric inguinal hernia repair in several institutions. However, SILPEC requires at least two operators. We report the first SILPEC performed by a single surgeon using the Senhance robotic system for pediatric patients. The Senhance, which features reusable 3- to 5-mm instruments and tremor filtering, allows both eye-tracked and manually adjustable camera control via a standalone robotic arm, resulting in stable, assistant-free visualization while preserving the small port philosophy. Two pediatric patients with inguinal hernia underwent SILPEC. The laparoscope was mounted on one robotic arm, and a 3-mm curved grasper was manipulated manually through the same incision. Operative times were 71 and 77 min, without blood loss, conversions, or perioperative complications. Both patients remained recurrence-free. This report demonstrates the feasibility, safety, procedural efficiency, and potential cost-effectiveness of single-surgeon robotic assisted SILPEC, thus offering a pragmatic solution for understaffed pediatric surgical units.

DOI： 10.1111/ases.70131

Thoracoscopic Posterior Tracheopexy After Esophageal Atresia Repair: A Case Report Open Access

Makita, S; Uchida, H; Hinoki, A; Shirota, C; Tainaka, T; Amano, H; Yasui, A; Nakagawa, Y; Kato, D; Maeda, T; Ishii, H; Asai, H; Murata, Y; Utsunomiya, A; Liu, JH; Guo, YH

ASIAN JOURNAL OF ENDOSCOPIC SURGERY 18 巻 ( 1 ) 頁： e70128 2025年8月

記述言語：英語出版者・発行元：Asian Journal of Endoscopic Surgery

Esophageal atresia (EA) is frequently associated with tracheomalacia (TM). Recently, the use of posterior tracheopexy (PT) during EA repair for addressing TM has gained attention. Herein, we report a case of thoracoscopic PT in a 6-year-old boy with EA. Due to severe TM, tracheostomy was performed at 51 days of age. At 6 years of age, bronchoscopy still revealed significant collapse of the membranous portion of the trachea, extending from the subglottic area to the carina. Due to its capability to address a wider segment of the airway, thoracoscopic PT was selected for the treatment of TM. Four ports were placed in the right hemithorax, and the membranous portion of the trachea was sutured to the anterior longitudinal spinal ligament using four 3–0 nonabsorbable stitches. The patient was discharged uneventfully on postoperative Day 6. Postoperative computed tomography scan showed improved airway patency, and the patient exhibited resolution of exertional symptoms.

DOI： 10.1111/ases.70128

Emergency One-Stage Robotic Surgery for Congenital Biliary Dilatation With Bile Duct Perforation in a Pediatric Patient: A Case Report Open Access

Asai, H; Shirota, C; Tainaka, T; Makita, S; Ogawa, K; Okamoto, M; Yasui, A; Takada, S; Hayashi, K; Nakagawa, Y; Katou, D; Ishii, H; Utsunomiya, A; Uchida, H

ASIAN JOURNAL OF ENDOSCOPIC SURGERY 18 巻 ( 1 ) 頁： e70122 2025年7月

記述言語：英語出版者・発行元：Asian Journal of Endoscopic Surgery

Bile duct perforation is a rare, serious complication of congenital biliary dilatation (CBD). While traditionally managed with a two-stage surgical approach, recent reports suggest that one-stage, minimally invasive approaches may be feasible. We present the case of a 13-month-old female who developed bile duct perforation associated with a protein plug in the common channel. Following the correction of coagulopathy, emergency robotic surgery was performed, including bile duct excision and Roux-en-Y hepaticojejunostomy. Despite significant adhesions and an anatomical anomaly in which the right hepatic artery coursed anterior to the common hepatic duct, robotic dissection and reconstruction were safely completed. The postoperative course was uneventful, and the patient was discharged. This report highlights the feasibility and potential advantages of one-stage robotic surgery for CBD with perforation, even in the presence of active inflammation and vascular anomalies. Similar cases must be reported and evaluated to understand the indications and limitations of this approach.

DOI： 10.1111/ases.70122

Clinical outcomes of primary thoracoscopic repair in patients with esophageal atresia and tracheoesophageal fistula: A multicenter study from the East Asia pediatric surgery research consortium. Open Access

Tsuruno Y, Sugita K, Ota K, Fung ACH, Shigeta Y, Deie K, Onishi S, Chan IHY, Takezoe T, Miyake Y, Tsutsuno T, Shibuya S, Chung PHY, Shirota C, Tainaka T, Miyano G, Kawashima H, Wong KKY, Uchida H, Ieiri S

Journal of pediatric surgery 頁： 162470 2025年7月

記述言語：英語出版者・発行元：Journal of Pediatric Surgery

Purpose: Thoracoscopic repair for esophageal atresia/tracheoesophageal fistula (EA/TEF) has not been widely adopted despite its introduction nearly 25 years ago. We reviewed the clinical outcomes of primary thoracoscopic EA/TEF repair performed at 5 leading centers for minimally invasive pediatric surgery in East Asia. Methods: A retrospective review was conducted of patients with EA/TEF (Gross type C) who underwent primary thoracoscopic repair between 2008 and 2024. Patients with Gross type A/B/D/E, long-gap EA requiring staged repair, or trisomy18 were excluded. Collected data included demographics, surgical outcomes, and long-term outcomes. Results: A total of 127 patients underwent thoracoscopic repair for EA/TEF during the study period. The mean gestational age, birth weight, and age at surgery were 38 ± 2.1 weeks, 2540 ± 487 g, and 3.0 ± 7.5 days, respectively. Thirty patients (23.6 %) had cardiac anomalies, and 8 (6.3 %) had chromosomal anomalies (excluding trisomy18). The mean operative time and intraoperative blood loss were 191 ± 67 min and 4.3 ± 8.7 mL, respectively. Nine patients (7.1 %) required conversion to open surgery and 10 (7.9 %) required blood transfusions. The mean length of hospitalization was 74 ± 73 days. Postoperative complications included anastomotic leak in 8 (6.3 %) patients and chylothorax in 9 (7.1 %). The long-term outcomes included anastomotic stenosis requiring dilatation in 52 patients (41.6 %), gastroesophageal reflux (GER) in 49 patients (39.2 %), and recurrent TEF in 3 (2.4 %). Mortality case was recognized in 2 (1.6 %). Conclusion: The results of this study indicate that thoracoscopic repair for EA/TEF is a safe procedure when performed on selected patients and in centers with suitable thoracoscopic experience.

DOI： 10.1016/j.jpedsurg.2025.162470

下血，ショック状態，門脈ガス血症を認めた新生児ミルクアレルギーの1例 Open Access

尾形誠弥, 城田千代栄, 住田亙, 牧田智, 滝本愛太朗, 高田瞬也, 中川洋一, 合田陽祐, 檜顕成, 内田広夫

日本小児外科学会雑誌 61 巻 ( 4 ) 頁： 723 - 727 2025年6月

記述言語：日本語出版者・発行元：特定非営利活動法人日本小児外科学会

<p>下血，ショック状態，門脈ガス血症を呈した新生児ミルクアレルギー症例を経験した．患者は，在胎39週4日，3,020 gで出生した男児で，日齢1に嘔吐，日齢3に少量の鮮血便を認め近医で経過観察となっていたが，日齢8に哺乳不良，傾眠傾向，頻回嘔吐，赤褐色水様便を認め前医を受診した．下血，腹部単純X線検査で門脈ガス像，造影CTで腸管拡張を認めたため絞扼性腸閉塞が疑われ緊急手術目的で当院へ搬送された．超音波検査や造影CTでは全体的な腸管壁の肥厚を認めたが腸閉塞や腸管壊死の所見はなく，ミルクアレルギーを疑い保存的治療を行った．その後速やかに症状は改善し，アレルゲン特異的リンパ球刺激試験でκ・βカゼインとラクトフェリンが強陽性と判明し，ミルクアレルギーの診断が確定した．ショック状態，門脈ガス血症を呈していても腹部所見や造影CT画像などの検査所見を十分に検討し，ミルクアレルギーも含めた鑑別診断を行うことが重要と考えられた．</p>

DOI： 10.11164/jjsps.61.4_723

Vitamin K deficiency bleeding and optimal prophylaxis methods in biliary atresia: A surveillance study in Japan Open Access

Okubo, R; Shirota, C; Wada, M; Shinkai, M; Tomita, H; Umeda, S; Miyake, H; Matsuura, T; Fumino, S; Odaka, A; Hibi, T; Harumatsu, T; Yokoi, A; Hishiki, T; Ono, S; Matsushita, K; Japanese Biliary Atresia Soc

PEDIATRICS INTERNATIONAL 67 巻 ( 1 ) 頁： e70075 2025年5月

記述言語：英語出版者・発行元：Pediatrics International

Background: Vitamin K (VK) prophylaxis refers to the administration of VK to newborns to prevent neonatal VK deficiency bleeding (VKDB), which is characterized by intracranial hemorrhage (ICH). This study investigated the relationship between VK prophylaxis methods and VKDB in biliary atresia (BA). Methods: The survey targeted 497 cases in the Japanese Biliary Atresia Registry between 2015 and 2019, of which 395 (79.5%) returned the questionnaire. Of the 395 patients, 289 were selected after excluding cases in which the gestational age was <36 weeks or the VK prophylaxis methods/feeding contents were unknown. The patients were categorized into two groups according to VK prophylaxis methods. We conducted a comparative study using propensity score matching. The prognosis of patients with or without ICH was also investigated. Results: In the analysis, no VKDB occurred in patients using the 3-month method. In the propensity score matching analysis, age at first visit and age at surgery were later in the three-times method (p = 0.018 and p = 0.022, respectively); VKDB was higher in the three-times method than in the 3-month method (p = 0.029). ICH, jaundice disappearance, cholangitis, and native liver survival rates (NLSRs) were not significantly different between groups. When examining the prognosis based on ICH occurrence, the two groups showed no significant differences in jaundice disappearance, cholangitis, and NLSRs. The ICH group had a greater number of cases of delayed mental and/or motor development. Conclusions: In BA, the 3-month method is effective in preventing VKDB, and early diagnosis is crucial.

DOI： 10.1111/ped.70075

Hyponatremia is not induced by postoperative hypotonic fluids in infants with biliary atresia after sufficient diuresis Open Access

Yokota, K; Uchida, H; Shirota, C; Tainaka, T; Sumida, W; Makita, S; Amano, H; Nakagawa, Y; Maeda, T; Gohda, Y; Kato, D; Hinoki, A

PEDIATRICS INTERNATIONAL 67 巻 ( 1 ) 頁： e70016 2025年5月

記述言語：英語出版者・発行元：Pediatrics International

Background: In Japan, the administration of extra-hypotonic fluids (approximately 35 mmol/L of sodium) as maintenance fluid is still the mainstream practice, and there have been relatively few reports on maintenance intravenous fluid therapy. Since 2014, our institution has administered maintenance fluids containing 83 mmol/L of Na (HALF) after diuresis is achieved post-Kasai portoenterostomy for biliary atresia (BA). We investigated whether hyponatremia is induced by the administration of half saline during postoperative maintenance of infants with BA. Methods: Patients who underwent surgery for BA at our institution were included. The serum sodium concentration ([Na]) before and after surgery and the incidence of hyponatremia were compared between patients administered fluids with [Na] of 35 mmol/L (exHYPO group, 59 patients) and those with [Na] of 83 mmol/L (HALF group, 20 patients). Results: The median age of patients was 59 days. There were no significant differences in the background or preoperative [Na] between groups. There was a significant decrease in [Na] on postoperative day 3 (POD3) in the exHYPO group compared with the preoperative [Na] value in the exHYPO group and the [Na] value on POD3 in the HALF group. There were no significant differences in [Na] before and after surgery in the HALF group. The odds ratio was 21.0, and the 95% confidence interval was 3.31–130, indicating that the exHYPO group had an increased risk of hyponatremia. Conclusion: Administration of half saline as maintenance fluid can maintain [Na] levels during postoperative care of infants with BA.

DOI： 10.1111/ped.70016

Young pediatric surgeons without endoscopic surgical skill qualification safely perform advanced endoscopic surgery under the supervision of expert qualified surgeons Open Access

Ota, K; Tainaka, T; Hinoki, A; Shirota, C; Makita, S; Yasui, A; Nakagawa, Y; Kato, D; Maeda, T; Ishii, H; Uchida, H

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 39 巻 ( 5 ) 頁： 2925 - 2930 2025年5月

記述言語：英語出版者・発行元：Surgical Endoscopy

Background: Young pediatric surgeons should receive adequate training in various minimally invasive surgeries (MIS). However, it is essential to maintain patient safety and outcomes during the learning process. In Japan, the endoscopic surgical skill qualification (ESSQ) system in pediatric surgery was initiated by the Japan Society for Endoscopic Surgery (JSES) in 2009 to objectively evaluate the skill of endoscopic surgeons. This study compared perioperative outcomes between pediatric surgeons with ESSQ qualifications and those without (non-ESSQ). Methods: We retrospectively reviewed the medical records of children with choledochal cyst (CC), lobectomy, and biliary atresia (BA) who underwent MIS at our hospital from 2013 to 2023. We assessed the performance of nonqualified surgeons assisted by supervisors with ESSQ qualifications. Results: This study included the records of 101 surgical cases with CC (operated by ESSQ: 36, non-ESSQ: 65), 78 patients with BA (operated by ESSQ: 35, non-ESSQ: 43), and 67 patients with lobectomy (operated by ESSQ: 31, non-ESSQ: 36). For the CC and lobectomy groups, there were no significant differences in operating time, blood loss, and postoperative complications (PO) between the ESSQ and non-ESSQ groups. In BA, the operative times for the ESSQ and non-ESSQ groups were 310 and 377 min, respectively (p = 0.001). Furthermore, no significant differences were observed in blood loss, PO, jaundice-clearance ratio, and jaundice-free survival rate with the native liver between the two groups. Conclusion: The results indicate that young pediatric surgeons can safely perform MIS while practicing under the supervision of experienced ESSQ-qualified surgeons.

DOI： 10.1007/s00464-025-11657-w

Learning curve comparison of robot-assisted and laparoscopic hepaticojejunostomy: a focus on critical suturing Open Access

Liu, JH; Maeda, T; Shirota, C; Tainaka, T; Sumida, W; Makita, S; Gohda, Y; Nakagawa, Y; Takimoto, A; Guo, YH; Kato, D; Yasui, A; Hinoki, A; Uchida, H

FRONTIERS IN PEDIATRICS 13 巻頁： 1558362 2025年3月

記述言語：英語出版者・発行元：Frontiers in Pediatrics

Background: Robot-assisted surgery (RS) has gained popularity due to its potential advantages over conventional laparoscopic surgery (LS). However, the specific suturing steps that benefit most from RS in terms of efficiency remain unclear. This study aimed to compare the suturing performance and learning curves of RS and LS during hepaticojejunostomy. Methods: We retrospectively analyzed surgical videos of patients who underwent hepaticojejunostomy performed by the same surgeon between 2016 and 2023. Cases with incomplete data or conversion to open surgery were excluded. Suturing efficiency, anastomotic precision, and learning curves were evaluated using standardized metrics. Results: A total of 33 patients were included in the final analysis (17 RS, 16 LS). The median suture time per stitch was significantly shorter in the RS group (P = 0.017). The greatest efficiency gains were observed at the second (P = 0.041) and final stitches (P = 0.041). Complication rates were comparable between the two groups (P = 0.986). Conclusion: RS significantly improves efficiency at challenging suturing steps and provides a more consistent learning curve, highlighting its potential advantage for complex pediatric procedures such as hepaticojejunostomy. Future multicenter studies with larger sample sizes and longer follow-up are needed to validate these results and explore long-term outcomes.

DOI： 10.3389/fped.2025.1558362

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