研究者詳細 - 城田　千代栄

論文 - 城田　千代栄

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Preoperative Contrast Examinations Help Determine the Appropriate Cervical Approach for Congenital Gross Type C Esophageal Atresia: A Report of Two Cases Open Access

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

AMERICAN JOURNAL OF CASE REPORTS 24 巻頁： e938723 2023年6月

記述言語：英語出版者・発行元：American Journal of Case Reports

Objective: Congenital defects/diseases Background: Kluth demonstrated that esophageal atresia/tracheoesophageal fistula (EA/TEF) has several anatomical variations and thus requires a preoperative imaging study to determine the surgical strategy. We routinely perform a contrast examination with iodixanol to assess the location of the TEF and the upper end of the esophageal pouch to determine the most appropriate approach. We herein present two cases of type C EA/TEF who successfully underwent radical surgery by a cervical approach based on the information from the contrast examination. Case Reports: Case 1 was a Japanese boy suspected of type C EA/TEF after birth. A contrast examination with iodixanol showed that a TEF was at the second thoracic vertebra (Th2), as was the upper end of the esophageal pouch. Thus, the patient underwent esophago-esophageal anastomosis and TEF ligation using a cervical approach; the postoperative course was uneventful. Case 2 was also a Japanese boy suspected of type C EA/TEF. A contrast examination showed that the TEF was at Th1-2, as was the upper end of the esophageal pouch. Thus, the patient underwent esophago-esophageal anastomosis and TEF ligation using a cervical approach. The patient suffered from congenital tracheal stenosis and required tracheoplasty. However, there were no apparent complications after the surgery. Conclusions: Here, we used the imaging information to adopt the cervical approach in type C EA/TEF cases and concluded that routine preoperative contrast examinations helped assess the TEF location and upper end of the esophageal pouch without significant complications.

DOI： 10.12659/AJCR.938723

CLINICAL VALIDATION OF NOVEL URINARY MARKERS FOR NEUROBLASTOMA DIAGNOSIS

Amano, H; Uchida, H; Harada, K; Narita, A; Kumano, S; Abe, M; Sakairi, M; Shirota, C; Tainaka, T; Sumida, W; Yokota, K; Makita, S; Osawa, T; Taguri, M; Takahashi, Y; Hinoki, A

PEDIATRIC BLOOD & CANCER 70 巻頁： S95 - S95 2023年6月

特集ロボット支援手術ロボット支援下胆管切除術

牧田智, 内田広夫, 住田亙, 檜顕成, 城田千代栄, 田井中貴久, 天野日出, 滝本愛太朗, 高田瞬也, 中川洋一, 合田陽祐, 前田拓也, 郭垚輝, 劉佳慧

小児外科 55 巻 ( 5 ) 頁： 544 - 551 2023年5月

Hemi-circumferential mucosal resection and anastomosis procedure for rectal prolapse following anorectoplasty for anorectal malformations

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

SURGERY TODAY 53 巻 ( 5 ) 頁： 628 - 632 2023年5月

記述言語：英語出版者・発行元：Surgery Today

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

Single-cell RNA sequencing of intestinal immune cells in neonatal necrotizing enterocolitis Open Access

Oshima, K; Hinoki, A; Uchida, H; Tanaka, Y; Okuno, Y; Go, Y; Shirota, C; Tainaka, T; Sumida, W; Yokota, K; Makita, S; Takimoto, A; Kano, Y; Sawa, S

PEDIATRIC SURGERY INTERNATIONAL 39 巻 ( 1 ) 頁： 179 2023年4月

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

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

Rare case of a right Bochdalek hernia with retroperitoneal prolapse of organs into the thoracic cavity in infancy: A case report

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

ASIAN JOURNAL OF ENDOSCOPIC SURGERY 16 巻 ( 2 ) 頁： 284 - 288 2023年4月

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

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

Laparoscopic bile duct plasty for hilar bile duct stenosis (HBDS) in patients with congenital biliary dilatation: Diagnosis of HBDS by preoperative MRCP and laparoscopic strategy to relieve HBDS

Nakagawa, Y; Uchida, H; Hinoki, A; Shirota, C; Tainaka, T; Sumida, W; Makita, S; Yasui, A; Takimoto, A; Guo, YH

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 30 巻 ( 4 ) 頁： 473 - 481 2023年4月

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

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

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 16 巻 ( 2 ) 頁： 275 - 278 2023年4月

記述言語：英語出版者・発行元：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

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 33 巻 ( 2 ) 頁： 220 - 225 2023年2月

記述言語：英語出版者・発行元：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 Open Access

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 30 巻 ( 2 ) 頁： 109 - 112 2023年2月

記述言語：英語出版者・発行元：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 Open Access

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 9 巻 ( 1 ) 頁： 5 2023年1月

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 Open Access

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 10 巻頁： 1090336 2023年1月

記述言語：英語出版者・発行元：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

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 16 巻 ( 1 ) 頁： 118 - 122 2023年1月

記述言語：英語出版者・発行元：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 16 巻 ( 1 ) 頁： 131 - 134 2023年1月

記述言語：英語出版者・発行元：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

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

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 65 巻 ( 1 ) 頁： e15454 2023年1月

記述言語：英語出版者・発行元：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

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 Open Access

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 46 巻 ( 0 ) 頁： 52 - 53 2023年

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 Open Access

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 Annual61 巻 ( Abstract ) 頁： 127_2 - 127_2 2023年

記述言語：日本語出版者・発行元：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 Open Access

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 10 巻頁： 1053154 2022年12月

記述言語：英語出版者・発行元：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 Open Access

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 22 巻 ( 1 ) 頁： 207 2022年12月

記述言語：英語出版者・発行元：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 Open Access

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 38 巻 ( 12 ) 頁： 1821 - 1827 2022年12月

記述言語：英語出版者・発行元：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

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