Faculty Profiles - SHIROTA Chiyoe

Papers - SHIROTA Chiyoe

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Laparoscopic internal intestinal drainage of bile lakes in a patient with recurrence of jaundice after laparoscopic revision of Kasai portoenterostomy for biliary atresia: A case report

Gohda, Y; Uchida, H; Hinoki, A; Shirota, C; Sumida, W; Makita, S; Okamoto, M; Ogata, S; Takimoto, A; Takada, S; Nakagawa, Y; Kato, D; Guo, YH

ASIAN JOURNAL OF ENDOSCOPIC SURGERY Vol. 16 ( 2 ) page： 275 - 278 2023.4

Language：English Publisher：Asian Journal of Endoscopic Surgery

Bile lake, of the postoperative complications after Kasai portoenterostomy (PE) for biliary atresia, causes cholangitis that may induce progressive fibrosis of the liver. Standard treatment for bile lakes has not yet been established, but there are reports that surgical internal intestinal drainage for bile lakes effectively prevents cholangitis and maintains jaundice-free status. In this case, insertion of the percutaneous transhepatic biliary drainage into the bile lake allowed continuous drainage of large volumes of bile juice. However, reoperation following laparotomy increases the surgical risk of subsequent liver transplantation due to postoperative adhesion. Laparoscopic surgery was selected for the patient who was likely to require liver transplantation in the future. In this case, laparoscopic internal intestinal drainage of bile lakes was performed safely by a Cavitron ultrasonic surgical aspirator for the recurrence of jaundice after laparoscopic revision of PE. Cholangitis and jaundice were rapidly resolved after this surgical procedure.

DOI： 10.1111/ases.13133

Update on aortopexy and posterior tracheopexy for tracheomalacia in patients with esophageal atresia

Sumida, W; Yasui, A; Shirota, C; Makita, S; Okamoto, M; Ogata, S; Takimoto, A; Takada, S; Nakagawa, Y; Kato, D; Gohda, Y; Amano, H; Guo, YH; Hinoki, A; Uchida, H

SURGERY TODAY Vol. 54 ( 3 ) page： 211 - 219 2023.2

Language：English Publisher：Surgery Today

Despite improving the survival after repair of esophageal atresia (EA), the morbidity of EA repair remains high. Specifically, tracheomalacia (TM) is one of the most frequent complications of EA repair. Continuous positive airway pressure is generally applied for the treatment of TM. However, surgical intervention is required against an apparent life-threatening event or inability to perform extubation for a long period. According to our review, most cases of TM showed symptom improvement after aortopexy. The ratio of the trachea’s lateral and anterior–posterior diameter at the brachiocephalic artery crossing the trachea, which reflects the compression of the trachea by the brachiocephalic artery, is a good indicator of aortopexy. Our finding suggests that most TM cases associated with EA may not be caused by tracheal fragility alone, but may involve blood vessel compression. Posterior tracheopexy (PT) is also an effective treatment for TM. Recently, open or thoracoscopic PT was able to be performed simultaneously with EA repair. In many cases, aortopexy or PT is a safe and effective surgical treatment for TM with EA. Other surgical procedures, such as external stenting, should be considered for patients with diffuse-type TM for whom aortopexy and PT appear relatively ineffective.

DOI： 10.1007/s00595-023-02652-6

Laparoscopic Duodenal-Caudal Detachment Method: Early Experience of a Novel Technique for Malrotation with Volvulus in Neonates

Takimoto, A; Amano, H; Sumida, W; Shirota, C; Yokota, K; Makita, S; Okamoto, M; Ogata, S; Takada, S; Nakagawa, Y; Kato, D; Goda, Y; Hinoki, A; Uchida, H

JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Vol. 33 ( 2 ) page： 220 - 225 2023.2

Language：English Publisher：Journal of Laparoendoscopic and Advanced Surgical Techniques

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

Endoscopic injection sclerotherapy with polidocanol for cardiac varices in children and adolescents

Yokoyama, S; Ishizu, Y; Honda, T; Imai, N; Ito, T; Yamamoto, K; Hinoki, A; Sumida, W; Shirota, C; Tainaka, T; Makita, S; Yokota, K; Uchida, H; Ishigami, M

ARCHIVES DE PEDIATRIE Vol. 30 ( 2 ) page： 109 - 112 2023.2

Language：English Publisher：Archives de Pediatrie

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

A new type of retropancreatic fascia hernia in the supramesocolic space preoperatively misdiagnosed as a diaphragmatic hernia: report of two cases

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

SURGICAL CASE REPORTS Vol. 9 ( 1 ) page： 5 2023.1

Laparoscopic restorative proctocolectomy with ileal-J-pouch anal canal anastomosis without diverting ileostomy for total colonic and extensive aganglionosis is safe and feasible with combined Lugol's iodine staining technique and indocyanine green fluorescence angiography

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

FRONTIERS IN PEDIATRICS Vol. 10 page： 1090336 2023.1

Language：English Publisher：Frontiers in Pediatrics

Background: We present the surgical technique and outcomes of reduced-port laparoscopic restorative proctocolectomy with ileal-J-pouch anal canal anastomosis (IPACA) without diverting ileostomy for total colonic and extensive aganglionosis (TCA+). Methods: We retrospectively reviewed TCA+ cases between 2014 and 2022. Preoperative ileostomy was performed when transanal bowel irrigation was ineffective. Radical surgery for TCA+ was performed at approximately 6 kg. The surgery was performed using laparoscopy through a multi-channel trocar with or without an additional 3-mm trocar and IPACA reconstruction with indocyanine green fluorescence angiography (ICG) to assess anastomotic perfusion and Lugol's iodine staining to visualize the surgical anal canal. Results: Ten patients with TCA+ were included. Ileostomy was performed in seven cases. The median operation time and blood loss were 274.5 min and 20 ml, respectively. No significant postoperative complications were found. All patients experienced frequent liquid stools and perianal excoriation in the early postoperative period, requiring anti-flatulence or codeine. The median follow-up period was 3.5 years. Three patients required irrigation management 1 year postoperatively, and the others defecated a median of 3.5 times per day. The median Kelly's clinical score was 5 in 5 patients aged >4 years. Conclusion: Reduced-port surgery, combined with Lugol's iodine staining and ICG, was safe, feasible, and had cosmetically and clinically acceptable mid-term outcomes.

DOI： 10.3389/fped.2022.1090336

The presence of high-risk varices after sclerotherapy in biliary atresia

Yokoyama, S; Ishizu, Y; Honda, T; Imai, N; Ito, T; Yamamoto, K; Shirota, C; Tainaka, T; Sumida, W; Makita, S; Takimoto, A; Nakagawa, Y; Takada, S; Ishigami, M; Uchida, H; Kawashima, H

PEDIATRICS INTERNATIONAL Vol. 65 ( 1 ) page： e15454 2023.1

Language：English Publisher：Pediatrics International

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/s patients than in those with LS <2.8 m/s (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.

DOI： 10.1111/ped.15454

Laparoscopic closure of Roux limb perforation during double-balloon endoscopic retrograde cholangiography with laparoscopy-assisted endoscopic hepatolithectomy 30 years after congenital biliary dilatation radical surgery: A case report

Nakagawa, Y; Uchida, H; Hinoki, A; Shirota, C; Sumida, W; Makita, S; Masamune, O; Ogata, S; Takimoto, A; Takada, S; Kato, D; Gohda, Y

ASIAN JOURNAL OF ENDOSCOPIC SURGERY Vol. 16 ( 1 ) page： 118 - 122 2023.1

Language：English Publisher：Asian Journal of Endoscopic Surgery

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

Retroperitoneoscopic resection of a large paraganglioma surrounded by the right diaphragmatic crus on the dorsal side of the inferior vena cava: A pediatric case report

Takimoto, A; Sumida, W; Shirota, C; Makita, S; Okamoto, M; Ogata, S; Takada, S; Nakagawa, Y; Kato, D; Goda, Y; Hinoki, A; Uchida, H

ASIAN JOURNAL OF ENDOSCOPIC SURGERY Vol. 16 ( 1 ) page： 131 - 134 2023.1

Language：English Publisher：Asian Journal of Endoscopic Surgery

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

先天性十二指腸閉鎖症・狭窄症に合併した膵・胆管合流異常の4例

牧田智, 内田広夫, 檜顕成, 寺脇幹, 城田千代栄, 田井中貴久, 住田亙, 横田一樹, 天野日出, 滝本愛太朗, 安井昭洋, 中川洋一, 加藤大幾, 合田陽祐, 前田拓也, 郭垚輝, 劉佳慧

日本膵・胆管合流異常研究会プロシーディングス Vol. 46 ( 0 ) page： 52 - 53 2023

AI画像解析による内視鏡外科手術手技のビデオ評価及び手術支援システムの構築

安井昭洋, 内田広夫, 森健策, 石田昇平, 出家亨一, 檜顕成, 城田千代栄, 小田昌宏, 林雄一郎

生体医工学 Vol. Annual61 ( Abstract ) page： 127_2 - 127_2 2023

Language：Japanese 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

Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report

Nakagawa, Y; Makita, S; Uchida, H; Hinoki, A; Shirota, C; Sumida, W; Amano, H; Okamoto, M; Takimoto, A; Ogata, S; Takada, S; Kato, D; Gohda, Y; Guo, YH

FRONTIERS IN PEDIATRICS Vol. 10 page： 1053154 2022.12

Language：English Publisher：Frontiers in Pediatrics

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

Preoperative imaging contributes to pathologically complete resection of the urachal remnant by determining an appropriate surgical approach without unnecessary and excessive surgical invasion: a retrospective study

Nakagawa, Y; Sumida, W; Amano, H; Uchida, H; Hinoki, A; Shirota, C; Makita, S; Okamoto, M; Ogata, S; Takimoto, A; Takada, S; Kato, D; Gohda, Y

BMC UROLOGY Vol. 22 ( 1 ) page： 207 2022.12

Language：English Publisher：BMC Urology

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

Laparoscopic revision of Kasai portoenterostomy after initial laparoscopic portoenterostomy in patients with biliary atresia: a limited but positive effect on native liver survival

Kato, D; Uchida, H; Amano, H; Hinoki, A; Shirota, C; Sumida, W; Yokota, K; Makita, S; Okamoto, M; Takimoto, A; Yasui, A; Takada, S; Nakagawa, Y

PEDIATRIC SURGERY INTERNATIONAL Vol. 38 ( 12 ) page： 1821 - 1827 2022.12

Language：English Publisher：Pediatric Surgery International

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

Adding a spur valve to laparoscopic portoenterostomy for patients with biliary atresia can achieve a high jaundice clearance rate and lower the number of episodes of cholangitis

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

PEDIATRIC SURGERY INTERNATIONAL Vol. 38 ( 12 ) page： 1881 - 1885 2022.12

Language：English Publisher：Pediatric Surgery International

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

Biochemical markers to predict the development of gastrointestinal bleeding and esophageal varices after portoenterostomy in biliary atresia

Sumida, W; Tainaka, T; Shirota, C; Yokota, K; Makita, S; Okamoto, M; Takimoto, A; Yasui, A; Takada, S; Nakagawa, Y; Kato, D; Yokoyama, S; Ishizu, Y; Amano, H; Guo, YH; Hinoki, A; Uchida, H

PEDIATRIC SURGERY INTERNATIONAL Vol. 38 ( 12 ) page： 1799 - 1805 2022.12

Language：English Publisher：Pediatric Surgery International

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

Combined negative pressure wound therapy with irrigation and dwell time and artificial dermis prevents infection and promotes granulation formation in a ruptured giant omphalocele: a case report

Nakagawa, Y; Uchida, H; Hinoki, A; Shirota, C; Sumida, W; Makita, S; Amano, H; Okamoto, M; Takimoto, A; Ogata, S; Takada, S; Kato, D; Gohda, Y

BMC PEDIATRICS Vol. 22 ( 1 ) page： 680 2022.11

Language：English Publisher：BMC Pediatrics

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

Case report: A giant bilateral inguinal hernia requiring artificial mesh and multi-stage surgery in infancy; hernioplasty with silo placement to prevent acute compartment syndrome

Nakagawa, Y; Makita, S; Uchida, H; Hinoki, A; Shirota, C; Sumida, W; Amano, H; Okamoto, M; Takimoto, A; Yasui, A; Ogata, S; Takada, S; Kato, D; Gohda, Y; Yaohui, G

FRONTIERS IN PEDIATRICS Vol. 10 page： 1030934 2022.11

Language：English Publisher：Frontiers in Pediatrics

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

Intraoperative indocyanine green fluorescence cholangiography can rule out biliary atresia: A preliminary report

Shirota, C; Hinoki, A; Togawa, T; Ito, S; Sumida, W; Makita, S; Amano, H; Takimoto, A; Takada, S; Okamoto, M; Nakagawa, Y; Kato, D; Uchida, H

FRONTIERS IN PEDIATRICS Vol. 10 page： 1005879 2022.11

Language：English Publisher：Frontiers in Pediatrics

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

Circumumbilical incision for neonatal abdominal surgery: additional skin incision when there is difficulty in manipulating the intestine

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

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 84 ( 4 ) page： 716 - 722 2022.11

Language：English Publisher：Nagoya Journal of Medical Science

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

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