Faculty Profiles - SHIROTA Chiyoe

Spleen stiffness by 2-D shear wave elastography is the most accurate predictor of high-risk esophagogastric varices in children with biliary atresia

Yokoyama, S; Ishigami, M; Honda, T; Kuzuya, T; Ishizu, Y; Ito, T; Hirooka, Y; Tanaka, Y; Tainaka, T; Shirota, C; Chiba, K; Uchida, H; Fujishiro, M

HEPATOLOGY RESEARCH Vol. 49 ( 10 ) page： 1162 - 1168 2019.10

Language：English Publisher：Hepatology Research

Aim: Esophagogastric variceal hemorrhage is a cause of poor prognosis in patients with biliary atresia (BA). To prevent variceal hemorrhage, simple and reliable screening methods for high-risk esophagogastric varices (HR-EGV) are needed. We evaluated the efficacy of liver stiffness (LS) and spleen stiffness (SS) as measured by 2-D shear wave elastography (2D-SWE), which was reported to be more accurate than transient elastography, for detecting HR-EGV in children with BA. Methods: Thirty-four children with BA were enrolled. Both LS and SS were measured by 2D-SWE. The presence of large esophageal varices or esophageal varices of any size with red wale marking and/or the presence of gastric varices along the cardia were defined as HR-EGV. Clinical data were collected and previously reported prediction indices for varices were calculated. Results: Liver stiffness and SS were obtained from all patients. Fourteen patients showed HR-EGV. Significantly different variables between patients with and without HR-EGV were as follows: spleen diameter (116 mm vs. 95 mm), clinical prediction rule (104.7 vs. 124.7), King's variceal prediction score (78.8 vs. 99.4), aspartic aminotransferase-to-platelet ratio index (2.03 vs. 0.98), LS (2.63 m/s vs. 1.87 m/s), and SS (4.44 m/s vs. 3.69 m/s). The highest area under the receiver operating characteristic curve for detecting HR-EGV was that for SS (0.900), and the cut-off SS of 4.12 m/s yielded 92.9% sensitivity and 90% specificity. The intraclass correlation coefficient for intra-observer reproducibility was 0.828. Conclusions: Spleen stiffness from 2D-SWE offered the most accurate predictor of HR-EGV in BA children.

DOI： 10.1111/hepr.13381

NON-INVASIVE SCREENING FOR DETECTING ESOPHAGOGASTRIC VARICES IN CHILDREN WITH BILIARY ATRESIA

Yokoyama, S; Ishigami, M; Honda, T; Kuzuya, T; Ishizu, Y; Ito, T; Shirota, C; Uchida, H; Fujishiro, M

HEPATOLOGY Vol. 70 page： 200A - 200A 2019.10

Nuss procedure for patients with pectus excavatum with a history of intrathoracic surgery

Takanari, K; Toriyama, K; Kambe, M; Nakamura, Y; Uchibori, T; Ebisawa, K; Shirota, C; Tainaka, T; Uchida, H; Kamei, Y

JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Vol. 72 ( 6 ) page： 1025 - 1029 2019.6

Language：English Publisher：Journal of Plastic, Reconstructive and Aesthetic Surgery

Background: The aim of this study was to demonstrate the feasibility and safety of the Nuss procedure for patients with pectus excavatum (PE) with a history of intrathoracic surgery. Patients: From April 2010 to December 2013, we performed 6 cases of PE repair in patients with a history of intrathoracic surgery. The causes of previous operations were congenital cystic adenomatoid malformation in 4 patients and congenital diaphragmatic hernia in 2. The patients’ median age was 5 years (range, 4–9 years) and median preoperative pectus severity index was 4.63 (range, 3.42–10.03). Their intraoperative and postoperative courses were reviewed retrospectively. Results: The mean overall operation time was 127.5 ± 17.0 minutes, and the mean operation time for endoscopic pneumolysis was 28.8 ± 12.3 minutes. Intraoperative exploration for pleural adhesion revealed that the endoscopic approach in the previous operation was associated with low pleural adhesion, and the open thoracotomy or laparotomy approach was associated with low to high pleural adhesion. One patient developed a pneumothorax on the first postoperative day. All the other patients had uneventful postoperative courses. All the patients received bar removal 2–3 years after bar insertion. One patient developed atelectasis after bar removal. All the other patients had an uneventful postoperative course. The mean postoperative follow-up time after bar removal was 20.1 ± 14.7 months. Conclusions: History of intrathoracic surgery seems not a contraindication for the Nuss procedure. However, perioperative complications should be carefully monitored in both the bar insertion and removal operations.

DOI： 10.1016/j.bjps.2018.12.027

A Novel Laparoscopic Surgery Model with a Device to Expand the Abdominal Working Space in Rats: The Influence of Pneumoperitoneum and Skin Incision Length on Postoperative Inflammatory Cytokines.

Murase N, Tainaka T, Uchida H, Hinoki A, Shirota C, Yokota K, Oshima K, Shirotsuki R, Chiba K, Tanaka Y

Journal of investigative surgery : the official journal of the Academy of Surgical Research Vol. 32 ( 1 ) page： 55 - 60 2019.1

Air test as a simple method of screening for Hirschsprung's disease

Sumida, W; Uchida, H; Ono, Y; Tanaka, Y; Tainaka, T; Shirota, C; Yokota, K; Oshima, K; Chiba, K

CLINICAL RADIOLOGY Vol. 73 ( 12 ) page： 1041 - 1045 2018.12

Language：English Publisher：Clinical Radiology

Aim: To present the technique and the diagnostic accuracy of the air test to diagnose Hirschsprung's disease (HD). Materials and methods: Children who attended hospital for chronic constipation (CC) between January 2012 and December 2016 for whom the air test was performed were enrolled. The test was conducted during contrast enema under fluoroscopic observation using 20–50 ml injections of air into the rectum through a 10 F Nelaton catheter. The demographics, results of the air test, and additional examinations, as well as the outcomes of subsequent treatments were analysed retrospectively. Results: The air test was conducted in 179 patients (median: 3 years, range: 0–14 years), and was positive in 150 and negative in 29 cases. Of the 29 patients with negative results, four were diagnosed with HD by rectal suction biopsy (RSB). Of the remaining 25 patients, RSB was conducted in seven and HD was excluded in all cases. In all 150 patients with positive air test results, CC was adequately controlled with conservative treatment. The sensitivity and specificity of the air test were 100% (4/4) and 85.7% (150/175), respectively. Conclusions: The air test can be used as a new non-invasive screening method for HD, performed simultaneously with contrast enema.

DOI： 10.1016/j.crad.2018.08.008

Introduction of resection of intrahepatic bile duct stenosis-causing membrane or septum into laparoscopic choledochal cyst excision

Tanaka, Y; Tainaka, T; Sumida, W; Hinoki, A; Shirota, C; Murase, N; Oshima, K; Shirotsuki, R; Chiba, K; Uchida, H

PEDIATRIC SURGERY INTERNATIONAL Vol. 34 ( 10 ) page： 1087 - 1092 2018.10

Language：English Publisher：Pediatric Surgery International

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

DOI： 10.1007/s00383-018-4320-7

Single-stage laparoscopic transanal pull-through modified Swenson procedure without leaving a muscular cuff for short- and long-type Hirschsprung disease: a comparative study

Yokota, K; Uchida, H; Tainaka, T; Tanaka, Y; Shirota, C; Hinoki, A; Kato, T; Sumida, W; Oshima, K; Chiba, K; Ishimaru, T; Kawashima, H

PEDIATRIC SURGERY INTERNATIONAL Vol. 34 ( 10 ) page： 1105 - 1110 2018.10

Language：English Publisher：Pediatric Surgery International

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

DOI： 10.1007/s00383-018-4318-1

Oral administration of eicosapentaenoic acid suppresses liver fibrosis in postoperative patients with biliary atresia

Sumida, W; Uchida, H; Tainaka, T; Shirota, C; Hinoki, A; Kato, T; Yokota, K; Oshima, K; Shirotuki, R; Chiba, K; Tanaka, Y

PEDIATRIC SURGERY INTERNATIONAL Vol. 34 ( 10 ) page： 1059 - 1063 2018.10

Language：English Publisher：Pediatric Surgery International

Purpose: Biliary atresia (BA) is characterized by progressive inflammation of the biliary system. This inflammation persists and causes liver fibrosis, although jaundice disappears after Kasai portoenterostomy (KP). We aimed to confirm whether the oral administration of eicosapentaenoic acid (EPA) suppresses liver fibrosis in postoperative patients with BA. Methods: We reviewed patients who underwent laparoscopic KP (lapKP) between January 2014 and September 2017. From December 2016, 30 mg/kg/day of EPA was orally administered to patients who opted to take medicine (EPA group). Patients who did not receive EPA were assigned to the non-EPA group. Mac-2 binding protein sugar chain modified isomer (M2BPGi) and hyaluronic acid (HA) levels were compared between the two groups in patients showing disappearance of jaundice at 6 months after the first lapKP. Results: Seventeen patients in the non-EPA group and 11 in the EPA group were enrolled. At 6 months after the first lapKP, 10 patients in the non-EPA group and six in the EPA group were without jaundice. M2BPGi and HA levels were significantly lower in the EPA group. Conclusions: Liver fibrosis was suppressed in patients without jaundice 6 months after lapKP, who were administered EPA. We believe that periductular inflammation was alleviated by EPA supplementation.

DOI： 10.1007/s00383-018-4313-6

Long-term outcomes and complications after laparoscopic-assisted anorectoplasty vs. posterior sagittal anorectoplasty for high- and intermediate-type anorectal malformation

Tainaka, T; Uchida, H; Tanaka, Y; Hinoki, A; Shirota, C; Sumida, W; Yokota, K; Makita, S; Oshima, K; Chiba, K; Ishimaru, T; Kawashima, H

PEDIATRIC SURGERY INTERNATIONAL Vol. 34 ( 10 ) page： 1111 - 1115 2018.10

Language：English Publisher：Pediatric Surgery International

Purpose: Laparoscopic-assisted anorectoplasty (LAARP) is a minimally invasive procedure in which the levator ani muscle is left to potentially improve postoperative fecal continence. This study aimed to retrospectively evaluate postoperative complications and long-term outcomes of fecal continence after LAARP and compare them to those after posterior sagittal anorectoplasty (PSARP). Methods: Forty-five male patients with high and intermediate anorectal malformation (aged ≥ 4 years) who underwent LAARP or PSARP (LAARP 29, PSARP 16) from 1999 to 2013 were included. Postoperative complications and postoperative fecal continence were retrospectively evaluated and compared. Postoperative complications were also compared before and after introducing a urethroscope during fistula resection. Results: Complications after LAARP and PSARP were seen in 12 vs. 2 cases (p = 0.09) of mucosal prolapse and in 9 vs. 1 case (p = 0.07) of posterior urethral diverticulum (PUD), respectively. The incidence of PUD decreased after introduction of a urethroscopy from 40% in 8/20 cases to 11% in 1/9 cases. No significant difference was found in terms of fecal continence in both groups. Conclusion: Through our study, greater improvement of postoperative fecal continence after LAARP has not been shown. LAARP was at higher risk for mucosal prolapse and PUD. However, precise dissection of the urethral fistula could be performed after the introduction of urethroscopy.

DOI： 10.1007/s00383-018-4323-4

Investigation of the feasibility and safety of single-stage anorectoplasty in neonates with anovestibular fistula Reviewed

Shirota, C; Suzuki, K; Uchida, H; Kawashima, H; Hinoki, A; Tainaka, T; Sumida, W; Murase, N; Oshima, K; Chiba, K; Makita, S; Tanaka, Y

PEDIATRIC SURGERY INTERNATIONAL Vol. 34 ( 10 ) page： 1117 - 1120 2018.10

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

Purpose: Anovestibular fistula (AVF) is the most common type of anorectal malformation in females. Delayed anorectoplasty with fistula dilatation is commonly performed during infancy; however, we have been actively performing anorectoplasty in neonates. We report the surgical complications and postoperative defecation function associated with single-stage anorectoplasty performed in neonates. Methods: Patients who underwent surgery for AVF between 2007 and 2017 at two institutions were retrospectively studied. The operation time, amount of bleeding, time to start oral intake, perioperative complications, and Kelly’s score were compared among patients who underwent surgery as neonates and those who underwent surgery as infants. Results: Eighteen neonates and 17 infants underwent anterior sagittal anorectoplasty. The median operation time and time to start oral intake were significantly shorter in the neonatal group (72 min; 3 days, respectively) than in the infant group (110 min, p = 0.0002; 5 days, p = 0.0024, respectively). Postoperative wound disruption was significantly more frequent in the infant group. Of the ten patients each in the neonatal and infant groups, there was no significant difference in Kelly’s score at age ≥ 4 years. Conclusion: Single-stage anorectoplasty in neonates with AVF can be feasibly performed and does not impair postoperative defecation function. Levels of evidence: III.

DOI： 10.1007/s00383-018-4324-3