2025/09/26 更新

写真a

アマノ ヒヅル
天野 日出
AMANO Hizuru
所属
医学部附属病院 小児外科 病院助教
職名
病院助教

学位 1

  1. 医学博士 ( 2020年3月   東京大学大学院医学系研究科 ) 

 

論文 63

  1. 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

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    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

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  2. 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

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  3. Global Utilization of Minimally Invasive Surgery: Practice and Challenges Open Access

    McGinnis, OC; Wesonga, AS; Amano, H; Loh, A; Biswas, A; Hollier, P; Ssekitoleko, RT; Mueller, JL; Fitzgerald, TN

    JOURNAL OF SURGICAL RESEARCH   313 巻   頁: 198 - 209   2025年9月

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    記述言語:英語   出版者・発行元:Journal of Surgical Research  

    Introduction: Uptake of minimally invasive surgery (MIS) in low- and middle-income countries (LMICs) has been slow due to various barriers. This study examined the experiences of surgeons across multiple countries, highlighting the complications and challenges that arise with MIS. Methods: Forty-one surgeons from Japan, Singapore, Uganda, the United States, Cambodia, Vietnam, and Malaysia completed 12-question surveys detailing the challenges of their MIS cases. Data were collected from April 2021 to February 2023, and descriptive statistics were generated. Results: A total of 198 MIS cases were reported by 36 surgeons during the study period. In LMICs, patients tended to be older (P < 0.001), more likely to be female (P < 0.001), and have fewer comorbidities (P < 0.01) than in high-income countries (HICs). Antireflux procedures, appendectomies, and cholecystectomies were the most common MIS performed. Surgical assistants varied, with Japanese surgeons reporting the highest usage of experienced surgeons as assistants (n = 53, 56%). Minimal blood loss was perceived for 80% of cases in HICs (n = 99), whereas greater than minimal blood loss was perceived in LMICs (n = 41, 55%; P < 0.001). While most HIC surgeons found cases easy (n = 93, 75%) with no technical challenges, a higher percentage of LMIC surgeons considered converting to open procedures (n = 5, 7%) or had to convert (n = 6, 8%; P < 0.001). Thematic grouping identified four key barriers in LMICs: access to resources, maintenance of equipment, difficult intraoperative pathology, and surgical training availability. Conclusions: This study highlights significant differences in the MIS experience between HICs and LMICs. Technical difficulties and intraoperative challenges were more frequent in LMICs, and all cases converted to open procedures originated from these regions. The identified barriers—access to resources, equipment maintenance, difficult intraoperative pathology, and surgical training—are critical areas that need targeted interventions.

    DOI: 10.1016/j.jss.2025.06.024

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  4. 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     2025年8月

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    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

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  5. Thoracoscopic Posterior Tracheopexy After Esophageal Atresia Repair: A Case Report

    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

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    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

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  6. 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     2025年5月

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    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

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  7. Developing an Effective Off-the-job Training Model and an Automated Evaluation System for Thoracoscopic Esophageal Atresia Surgery Open Access

    Yasui, A; Hayashi, Y; Hinoki, A; Amano, H; Shirota, C; Tainaka, T; Sumida, W; Makita, S; Kano, Y; Takimoto, A; Nakagawa, Y; Takuya, M; Kato, D; Gohda, Y; Liu, JH; Guo, YH; Mori, K; Uchida, H

    JOURNAL OF PEDIATRIC SURGERY   60 巻 ( 2 ) 頁: 161615   2025年2月

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

    Background: Pediatric minimally invasive surgery requires advanced technical skills. Off-the-job training (OJT), especially when using disease-specific models, is an effective method of acquiring surgical skills. To achieve effective OJT, it is necessary to provide objective and appropriate skill assessment feedback to trainees. We aimed to construct a system that automatically evaluates surgical skills based on forceps movement using deep learning (DL). Methods: Using our original esophageal atresia OJT model, participants were tasked with performing esophageal anastomosis. All tasks were recorded for image analysis. Based on manual objective skill assessments, each participant's surgical skills were categorized into two groups: good and poor. The motion of the forceps in both groups was used as training data. Employing this training data, we constructed an automated system that recognized the movement of forceps and determined the quality of the surgical technique. Results: Thirteen participants were assigned to the good skill group and 32 to the poor skill group. These cases were validated using an automated skill assessment system. This system showed a precision of 75%, a specificity of 94%, and an area under the receiver operating characteristic curve of 0.81. Conclusions: We constructed a system that automatically evaluated the quality of surgical techniques based on the movement of forceps using DL. Artificial intelligence diagnostics further revealed the procedures important for suture manipulation. Levels of Evidence: Level IV

    DOI: 10.1016/j.jpedsurg.2024.06.023

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  8. Evaluation of the risk factors for postoperative pectus excavatum and scoliosis in cystic lung disease. Open Access

    Takahisa T, Chiyoe S, Wataru S, Satoshi M, Hizuru A, Yoko K, Akihiro Y, Daiki K, Takuya M, Yousuke G, Hiroki I, Kazuki O, Akinari H, Hiroo U

    Pediatric surgery international   41 巻 ( 1 ) 頁: 62   2025年1月

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  9. 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1月

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    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

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  10. Usefulness of lateral-anteroposterior dimeter ratio in patients with tracheomalacia associated with esophageal atresia

    Sumida, W; Tainaka, T; Shirota, C; Makita, S; Amano, H; Yasui, A; Maeda, T; Kato, D; Goda, Y; Ishii, H; Ota, K; Yaohui, G; Jiahui, L; Hinoki, A; Uchida, H

    PEDIATRIC SURGERY INTERNATIONAL   40 巻 ( 1 ) 頁: 282   2024年10月

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

    Purpose: Tracheomalacia (TM) is commonly associated with esophageal atresia (EA) and compression by the brachiocephalic artery is a factor for TM. Previous research has focused on the lateral-to-anteroposterior tracheal diameter ratio (LAR). This study aimed to assess the LAR and postoperative outcomes of EA patients. Methods: Patients undergoing thoracoscopic repair for EA between March 2020 and October 2023 were enrolled. Posterior tracheopexy (PT) was performed during thoracoscopic repair of EA on patients with bronchoscopy-confirmed TM; clinical courses and LAR were retrospectively analyzed. Results: Overall, 18 patients were enrolled; 14 patients underwent PT. Their median preoperative and postoperative LARs were 2.26 and 1.50, respectively; this difference was statistically significant. Four patients without TM did not undergo PT and their median LAR was 1.59. Median LAR for patients without PT was lower than that of preoperative patients with PT and no statistical differences were observed from that of postoperative patients with PT. The patients whose LAR improved with PT did not require further surgical intervention for TM. One patient who had a postoperative LAR of 2.25 required external tracheal stenting. Conclusion: LAR is a useful index for determining the severity of TM associated with EA. LAR can reflects the efficacy of PT.

    DOI: 10.1007/s00383-024-05877-9

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  11. First pediatric pelvic surgery with the Senhance® robotic surgical system: A case series Open Access

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

    ASIAN JOURNAL OF ENDOSCOPIC SURGERY   17 巻 ( 4 ) 頁: e13379   2024年10月

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

    The Senhance® robotic system (Senhance [Asensus Surgical Inc., Naderhan, NC, USA]) is a new surgical assistive robot following the da Vinci Surgical System that has been demonstrated to be safe and efficacious. Herein, we report the first case series of pediatric pelvic surgery using Senhance. Two anorectoplasties and one rectal pull-through coloanal anastomosis for rectal stenosis were performed in three children (5–9 months, 7–9 kg) using a 10-mm three-dimensional (3D) 4K camera and 3 and 5 mm forceps operated with Senhance. None of the patients had intraoperative complications or a good postoperative course. Pediatric pelvic surgery with Senhance could be performed precisely and safely with a small body cavity. With its beautiful 3D images, motion of forceps with reduced tremor, and availability of 3-mm forceps, Senhance may be better suited for children compared with other models.

    DOI: 10.1111/ases.13379

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  12. 特集 必携小児外科レジデントマニュアル2 手術器具

    田井中 貴久, 城田 千代栄, 牧田 智, 天野 日出, 檜 顕成, 内田 広夫

    小児外科   56 巻 ( 9 ) 頁: 933 - 937   2024年9月

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    出版者・発行元:東京医学社  

    DOI: 10.24479/ps.0000000944

    CiNii Research

  13. Eicosapentaenoic acid administration ameliorates the progression of liver fibrosis after laparoscopic Kasai portoenterostomy Open Access

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

    PEDIATRIC SURGERY INTERNATIONAL   40 巻 ( 1 ) 頁: 239   2024年8月

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

    Purpose: Biliary atresia (BA) poses a persistent challenge characterized by ongoing liver inflammation and subsequent fibrosis even after the clearance of jaundice (COJ). This study aimed to evaluate the therapeutic potential of eicosapentaenoic acid (EPA) in alleviating liver inflammation and limiting fibrosis during the post-COJ phase of BA. Methods: Among the BA patients undergoing laparoscopic Kasai portoenterostomy (lapKP) between December 2016 and October 2021, EPA (20–40 mg/kg/day) was administered orally to those whose parents consented. The study included patients from January 2014 to October 2021, classifying them into two groups: EPA-treated (Group E) and untreated (Group N). Their liver fibrosis and clinical course at 1 and 2 years post-lapKP were compared. Results: Group E consisted of 25 patients, while Group N comprised 32 patients. Twenty-one patients in Group E and 25 patients in Group N achieved COJ (p = 0.74). Among jaundice-free patients at 1 and 2 years post-lapKP, Group E exhibited significantly lower M2BPGi levels and platelet counts, and Group E showed a significant reduction in Aminotransferase-to-Platelet Ratio Index (APRI) at 2 years post-lapKP. Conclusion: Although EPA administration did not improve COJ, it attenuated the progression of liver fibrosis during the 2 years following lapKP in jaundice-free patients. (200/200Words).

    DOI: 10.1007/s00383-024-05800-2

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  14. Cholestasis after Kasai operation predicts portal hypertension in native liver survivors of biliary atresia: a multicenter study Open Access

    Chung, PHY; Harumatsu, T; Nakagawa, Y; Tsuboi, K; Chan, EKW; Leung, MWY; Yeung, FY; Muto, M; Kawano, T; Amano, H; Shirota, C; Nakamura, H; Koga, H; Miyano, G; Yamataka, A; Ieiri, S; Uchida, H; Wong, KKY

    PEDIATRIC SURGERY INTERNATIONAL   40 巻 ( 1 ) 頁: 196   2024年7月

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

    Purpose: This study evaluated portal hypertension (PHT) and its predictors among native liver survivors (NLS) of biliary atresia (BA) after Kasai portoenterostomy (KPE). Methods: This was a multicenter study using prospectively collected data. The subjects were patients who remained transplant-free for 5 years after KPE. Their status of PHT was evaluated and variables that predicted PHT were determined by regression analysis and receiver operating characteristic (ROC) curve. Results: Six centers from East Asia participated in this study and 320 subjects with KPE between 1980 to 2018 were analyzed. The mean follow-up period was 10.6 ± 6.2 years. At the 5th year after KPE, PHT was found in 37.8% of the subjects (n = 121). Patients with KPE done before day 41 of life had the lowest percentage of PHT compared to operation at older age. At 12 months after KPE, PHT + ve subjects had a higher bilirubin level (27.1 ± 11.7 vs 12.3 ± 7.9 µmol/L, p = 0.000) and persistent jaundice conferred a higher risk for PHT (OR = 12.9 [9.2–15.4], p = 0.000). ROC analysis demonstrated that a bilirubin level above 38 µmol/L at 12 months after KPE predicted PHT development (sensitivity: 78%, specificity: 60%, AUROC: 0.75). Conclusions: In BA, early KPE protects against the development of PHT among NLSs. Patients with persistent cholestasis at one year after KPE are at a higher risk of this complication. They should receive a more vigilant follow-up. Level of evidence: Level III

    DOI: 10.1007/s00383-024-05775-0

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  15. Scoring system for diagnosis and pretreatment risk assessment of neuroblastoma using urinary biomarker combinations Open Access

    Amano, H; Uchida, H; Harada, K; Narita, A; Fumino, S; Yamada, Y; Kumano, S; Abe, M; Ishigaki, T; Sakairi, M; Shirota, C; Tainaka, T; Sumida, W; Yokota, K; Makita, S; Karakawa, S; Mitani, Y; Matsumoto, S; Tomioka, Y; Muramatsu, H; Nishio, N; Osawa, T; Taguri, M; Koh, K; Tajiri, T; Kato, M; Matsumoto, K; Takahashi, Y; Hinoki, A

    CANCER SCIENCE   115 巻 ( 5 ) 頁: 1634 - 1645   2024年5月

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    記述言語:英語   出版者・発行元:Cancer Science  

    The urinary catecholamine metabolites, homovanillic acid (HVA) and vanillylmandelic acid (VMA), are used for the adjunctive diagnosis of neuroblastomas. We aimed to develop a scoring system for the diagnosis and pretreatment risk assessment of neuroblastoma, incorporating age and other urinary catecholamine metabolite combinations. Urine samples from 227 controls (227 samples) and 68 patients with neuroblastoma (228 samples) were evaluated. First, the catecholamine metabolites vanillactic acid (VLA) and 3-methoxytyramine sulfate (MTS) were identified as urinary marker candidates through comprehensive analysis using liquid chromatography–mass spectrometry. The concentrations of these marker candidates and conventional markers were then compared among controls, patients, and numerous risk groups to develop a scoring system. Participants were classified into four groups: control, low risk, intermediate risk, and high risk, and the proportional odds model was fitted using the L2-penalized maximum likelihood method, incorporating age on a monthly scale for adjustment. This scoring model using the novel urine catecholamine metabolite combinations, VLA and MTS, had greater area under the curve values than the model using HVA and VMA for diagnosis (0.978 vs. 0.964), pretreatment risk assessment (low and intermediate risk vs. high risk: 0.866 vs. 0.724; low risk vs. intermediate and high risk: 0.871 vs. 0.680), and prognostic factors (MYCN status: 0.741 vs. 0.369, histology: 0.932 vs. 0.747). The new system also had greater accuracy in detecting missing high-risk neuroblastomas, and in predicting the pretreatment risk at the time of screening. The new scoring system employing VLA and MTS has the potential to replace the conventional adjunctive diagnostic method using HVA and VMA.

    DOI: 10.1111/cas.16116

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  16. Duodenal duplication cyst at the second part of the duodenum with congenital duodenal position anomaly completely resected by laparoscopic partial duodenectomy: a case report Open Access

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

    SURGICAL CASE REPORTS   10 巻 ( 1 ) 頁: 73   2024年3月

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  17. A systematic review of Sandifer syndrome in children with severe gastroesophageal reflux Open Access

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

    PEDIATRIC SURGERY INTERNATIONAL   40 巻 ( 1 ) 頁: 91   2024年3月

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

    Purpose: Sandifer syndrome (SS), which combines gastroesophageal reflux (GER) and a neurological or psychiatric disorder, is an uncommon condition that often takes a long time to diagnosis. We aimed to systematically review available papers regarding SS. Methods: After presenting our two cases of SS, we systematically reviewed articles published in MEDILINE/PubMed, Cochrane Library, and Web of Science. Results: The meta-analysis included 54 reported cases and 2 of our own cases. Our results showed that all cases achieved symptom improvement with appropriate treatment for GER. Notably, 19 of the 56 cases exhibited anatomical anomalies, such as hiatal hernia and malrotation. Significantly more patients with than without anatomical anomalies required surgery (p < 0.001). However, 23 of the 29 patients without anatomical anomalies (79%) achieved symptom improvement without surgery. Patients who did not undergo surgery had a median (interquartile range) duration to symptom resolution of 1 (1–1) month. Conclusion: The primary care providers should keep SS in the differential diagnosis of patients presenting with abnormal posturing and no apparent neuromuscular disorders. Fundoplication may be effective especially for patients with anatomical anomalies or those whose symptoms do not improve after more than 1 month with nonsurgical treatment.

    DOI: 10.1007/s00383-024-05683-3

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  18. Laparoscopic Fundoplication in Patients with Ventriculoperitoneal Shunts: A Systematic Review and Our Experience Open Access

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

    JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES   34 巻 ( 3 ) 頁: 268 - 273   2024年3月

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    記述言語:英語   出版者・発行元:Journal of Laparoendoscopic and Advanced Surgical Techniques  

    Background: Data on the outcomes of laparoscopic fundoplication (LF) in patients with ventriculoperitoneal (VP) shunts are limited. Materials and Methods: We retrospectively evaluated the demographic characteristics and outcomes of patients who underwent LF at our institutions between 2014 and 2022. Then, we systematically reviewed articles in MEDILINE/PubMed, Cochrane Library, and Web of Science. Results: There was no significant difference in terms of the outcomes between patients with VP shunt (n = 10) and those without (n = 96) at our institutions. None of the patients presented with shunt trouble after LF. The meta-analysis included four retrospective studies and our institutional data. In total, 605 patients (55 with VP shunt) underwent LF. Furthermore, 2 (3.6%) of 55 patients (1 with infection and 1 with occlusion) had shunt troubles. The conversion and complication rates, operative time, and length of hospital stay did not significantly differ between patients with VP shunt and those without. Conclusions: LF can be safely performed on children with VP shunts and is associated with a low risk of shunt troubles.

    DOI: 10.1089/lap.2023.0220

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  19. 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   54 巻 ( 3 ) 頁: 211 - 219   2024年3月

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    記述言語:英語   出版者・発行元: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

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  20. Inverse Pairs Boosting (IPB) technique for preclinical cancer detection: A novel approach with urine metabolomics

    Baba, T; Sunagawa, M; Yamaguchi, J; Mizuno, T; Kokuryo, T; Yokoyama, Y; Amano, H; Hinoki, A; Uchida, H; Ebata, T

    CANCER SCIENCE   115 巻   頁: 1506 - 1506   2024年3月

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  21. Surgical Strategies for Neonates with Prenatally Diagnosed Congenital Biliary Dilatation Open Access

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

    JOURNAL OF PEDIATRIC SURGERY   59 巻 ( 3 ) 頁: 385 - 388   2024年3月

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

    Background: This study aimed to develop a postnatal treatment strategy for infants with prenatally diagnosed congenital biliary dilatation. Methods: We performed a retrospective study of patients with prenatal diagnosed congenital biliary dilatation (CBD), aged <1 year who underwent surgery at our hospital between 2013 and 2023. We classified the patients into two groups, the “early group,” consisting of patients who could not wait for growth, and required early surgery, and the “scheduled group,” consisting of patients who were asymptomatic and could undergo scheduled surgery, and compared them. The parameters for early surgical prediction were AST, ALT, TB, DB, and CRP levels at birth, 1 week, 2 weeks, 1 month, 2 months, and 3 months after birth, and immediately before surgery, as well as the cyst diameter, presence of intrahepatic bile duct dilation, and presence of debris in the common bile duct. Results: During the study period, 15 patients were diagnosed prenatally. The cyst diameter was significantly larger at all points in the early group. Patients with a cyst diameter of >30 mm at birth, intrahepatic bile duct dilatation at birth, and postnatal enlargement of the common bile duct to >30 mm are more likely to develop symptoms early. Blood biochemistry tests showed no significant differences between the two groups. Conclusions: Patients with a cyst diameter >30 mm in the early postnatal period require careful postnatal management and parents should be counseled regarding the high likelihood of their child needing surgery within the first 3 months of life. Level of evidence: Level IV.

    DOI: 10.1016/j.jpedsurg.2023.10.045

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  22. 当院におけるロボット支援腹腔鏡下胆道拡張症手術について Open Access

    田井中 貴久, 城田 千代栄, 牧田 智, 里見 美和, 狩野 陽子, 安井 昭和, 中川 洋一, 加藤 大幾, 前田 拓也, 石井 宏樹, 太田 和樹, 天野 日出, 檜 顕成, 内田 広夫

    日本膵・胆管合流異常研究会プロシーディングス   47 巻 ( 0 ) 頁: 62 - 63   2024年

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    記述言語:日本語   出版者・発行元:日本膵・胆管合流異常研究会  

    DOI: 10.34410/jspbm.47.0_62

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  23. Anastomotic time was associated with postoperative complications: a cumulative sum analysis of thoracoscopic repair of tracheoesophageal fistula in a single surgeon's experience

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

    SURGERY TODAY   53 巻 ( 12 ) 頁: 1363 - 1371   2023年12月

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    記述言語:英語   出版者・発行元:Surgery Today  

    Purpose: This study aimed to evaluate the learning curve of thoracoscopic repair of tracheoesophageal fistula (TEF) by a single surgeon using a cumulative sum (CUSUM) analysis. Methods: Prospective clinical data of consecutive Gross type-C TEF repairs performed by a pediatric surgeon from 2010 to 2020 were recorded. CUSUM charts for anastomosis and operating times were generated. The learning curves were compared with the effect of accumulation based on case experience. Results: For 33 consecutive cases, the mean operative and anastomosis times were 139 ± 39 min and 3137 ± 1110 s, respectively. Significant transitions beyond the learning phase for total operating and anastomosis times were observed at cases 13 and 17. Both the total operating time and anastomosis time were significantly faster in the proficiency improvement phase than in the initial learning phase. Postoperative complications significantly decreased after the initial anastomosis learning phase but not after the initial total operating learning phase. Conclusions: Thoracoscopic repair of TEF is considered safe and feasible after 13 cases, where the surgeon can improve their proficiency with the total operation procedure, and 17 cases, which will enable the surgeon to achieve proficiency in anastomosis. Postoperative complications significantly decreased after gaining familiarity with the anastomosis procedure through the learning phase.

    DOI: 10.1007/s00595-023-02687-9

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  24. Application of indocyanine green fluorescence imaging navigation in pediatric surgery: A single-center review Open Access

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

    JOURNAL OF PEDIATRIC SURGERY OPEN   4 巻   2023年12月

  25. Preoperative management comprising tube irrigation using a trans-anal indwelling tube for infants with hirschsprung disease can allow single-stage radical surgery Open Access

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

    BMC SURGERY   23 巻 ( 1 ) 頁: 333   2023年11月

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    記述言語:英語   出版者・発行元:BMC Surgery  

    Background: Preoperative management of Hirschsprung’s disease (HD) is currently being conducted with the goal of performing single-stage radical surgery without ileostomy. Methods: We retrospectively reviewed HD cases between 2013 and 2022, as well as their outcomes related to preoperative management. Results: Thirty-nine patients with HD were included in this study, including short-segment HD (30 cases), long-segment HD (4 cases), and total colonic aganglionosis (5 cases). Among these 39 patients, 95% (37 of 39 patients) underwent single-stage radical surgery after management with glycerin enema use (n = 13), irrigation with tube insertion each time irrigation was performed (n = 13), and irrigation using a tube placed in the bowel (n = 11). Conclusions: Preoperative management of patients with HD allowed for single-stage surgery of long-segment HD and total colonic aganglionosis. Cases that could be managed without performing an emergency enterostomy during the neonatal period were managed with irrigation until radical surgery was performed.

    DOI: 10.1186/s12893-023-02232-y

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  26. Refractory esophageal anastomotic stricture after esophageal atresia surgery improved with retrograde balloon dilatation through gastrostomy followed by laparoscopic fundoplication: a case report Open Access

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

    SURGICAL CASE REPORTS   9 巻 ( 1 ) 頁: 169   2023年9月

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  27. Robotic versus laparoscopic radical surgery for pediatric congenital biliary dilatation: a comparison of surgical outcomes of a single surgeon's initial experience Open Access

    Maeda, T; Liu, JH; Uchida, H; Amano, H; Shirota, C; Tainaka, T; Sumida, W; Makita, S; Takimoto, A; Takada, S; Nakagawa, Y; Gouda, A; Guo, YH; Hinoki, A

    PEDIATRIC SURGERY INTERNATIONAL   39 巻 ( 1 ) 頁: 261   2023年9月

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

    Purpose: This study aimed to clarify the validity of robot-assisted surgery (RAS) for pediatric patients with congenital biliary dilatation (CBD). Methods: We retrospectively compared RAS and laparoscopic surgery (LS) for pediatric CBD performed by the same certified surgeon between 2016 and 2022. Results: We included 6 RAS and 12 LS cases in this study. One case of RAS with laparotomy was excluded from the analysis. The patients in the two groups had comparable ages and body weights. The median surgery duration, the suture time per stitch, and the time to drain removal were 385 min, 145 s, and 5 days in the RAS group and 370 min (p = 0.28), 177 s (p = 0.03), and 6 days (p = 0.03) in the LS group, respectively. The time to create the Roux-en-Y limb was significantly longer in the RAS group. Postoperative complications occurred in one RAS case and in four LS cases. Conclusions: Less anastomotic time per stitch and less time to drain removal suggest that RAS may contribute to accurate suturing and fine intra-pancreatic bile duct dissection. In addition, RAS requiring large movements of forceps in a large surgical field, such as Roux-en-Y creation, is inferior to LS.

    DOI: 10.1007/s00383-023-05548-1

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  28. Management of Congenital and Postoperative Chylothorax: Use of Thoracoscopic Lymphatic Leak Ligations with Intraoperative ICG Lymphangiography Open Access

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

    JOURNAL OF PEDIATRIC SURGERY   58 巻 ( 9 ) 頁: 1754 - 1761   2023年9月

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

    Background: Congenital chylothorax (CCT) and postoperative chylothorax (POCT) are rare and difficult to treat. We report our treatment strategy and outcomes for chylothorax, including thoracoscopic surgery with indocyanine-green (ICG) near-infrared fluorescence lymphangiography. Methods: A retrospective review of patients with CCT and POCT from 2014 to 2021 was performed. After definitive diagnosis, conservative treatments with octreotide, followed by intravenous steroids as needed, were performed. Patients who were refractory to conservative treatment were transferred to surgical treatment, consisting of thoracoscopic lymphatic leak ligations using ICG intraoperative lymphangiography. The effectiveness of conservative and surgical treatment was then examined. Results: We included 19 cases of CCT and 31 cases of POCT. The 31 POCT patients included 23 of 84 postoperative patients with congenital diaphragmatic hernia (CDH), 7 of 54 postoperative patients with esophageal atresia (EA), and 1 of 3 postoperative patients with lymphatic malformation. The efficacy of conservative treatment was 12/19 for CCT, 22/23 for CDH, and 4/7 for EA. Surgical intervention was performed in 10 patients, and the rate of resolution of chylothorax within 3 weeks after surgery was 90%. Conclusion: Thoracoscopic lymphatic leak ligations with intraoperative ICG lymphangiography are feasible and useful in patients with chylothorax refractory to conservative treatment. Level of evidence: Level IV

    DOI: 10.1016/j.jpedsurg.2022.11.018

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  29. Case report: Laparoscopic gastrojejunostomy for duodenal atresia with situs inversus and preduodenal portal vein: a report of two cases Open Access

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

    FRONTIERS IN PEDIATRICS   11 巻   頁: 1220393   2023年6月

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

    Congenital duodenal atresia with situs inversus is occasionally accompanied by a preduodenal portal vein (PDPV), which is incidentally diagnosed during surgery. Duodenoduodenostomy is the most common and effective treatment. However, some patients require other anastomoses. Here, we present two cases of laparoscopic gastrojejunostomy for congenital duodenal atresia with situs inversus and PDPV and describe the reason for selecting gastrojejunostomy. The optimal surgical strategy is patient specific and should be determined based on the patient's general and physical condition.

    DOI: 10.3389/fped.2023.1220393

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  30. Case Report: Retropancreatic fascia hernia protruding into the thoracic cavity through a Bochdalek hernia Open Access

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

    FRONTIERS IN PEDIATRICS   11 巻   頁: 1149515   2023年6月

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

    Retropancreatic fascia hernia is a novel internal hernia originating from the retropancreatic fascial defect, which subsequently expands toward the dorsal aspect of the pancreatic body and migrates into the retroperitoneal space. We encountered a rare case of concomitant retropancreatic fascia and Bochdalek hernias. Here, we describe the imaging characteristics of this hernia type and its surgical strategies.

    DOI: 10.3389/fped.2023.1149515

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  31. 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

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    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

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  32. 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

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  33. 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

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    出版者・発行元:東京医学社  

    DOI: 10.24479/ps.0000000451

    CiNii Research

  34. 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

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    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

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  35. 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

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    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

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  36. Editorial: Infants with cholestasis Open Access

    Uchida, H; Tiao, GM; Shivakumar, P; Wong, KKY; Asai, A; Amano, H

    FRONTIERS IN PEDIATRICS   11 巻   頁: 1175231   2023年3月

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

    DOI: 10.3389/fped.2023.1175231

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  37. 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

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    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

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  38. 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

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  39. 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

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    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

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  40. 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

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    記述言語:日本語   出版者・発行元:日本膵・胆管合流異常研究会  

    DOI: 10.34410/jspbm.46.0_52

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  41. 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

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    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

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  42. 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

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    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

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  43. 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

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

    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   38 巻 ( 12 ) 頁: 1799 - 1805   2022年12月

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    記述言語:英語   出版者・発行元: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

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  45. 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   38 巻 ( 12 ) 頁: 1881 - 1885   2022年12月

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    記述言語:英語   出版者・発行元: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

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  46. 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 Open Access

    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   22 巻 ( 1 ) 頁: 680   2022年11月

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    記述言語:英語   出版者・発行元: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

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  47. 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 Open Access

    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   10 巻   頁: 1030934   2022年11月

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    記述言語:英語   出版者・発行元: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

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  48. Intraoperative indocyanine green fluorescence cholangiography can rule out biliary atresia: A preliminary report Open Access

    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   10 巻   頁: 1005879   2022年11月

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    記述言語:英語   出版者・発行元: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

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  49. Social injustice symposium: Urban, rural, and global disparities in access to care

    Amano, H; Krakauer, K; Moss, RL; Petroze, R; Reynolds, E; Shekherdimian, S; Walsh, D; Garcia, V; Gerstle, JT; Gow, K; Fitzgerald, TN; Krishnaswami, S

    JOURNAL OF PEDIATRIC SURGERY   57 巻 ( 11 ) 頁: 624 - 631   2022年11月

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

    Background: Barriers in access to pediatric surgical care are common in low- and middle-income countries (LMICs), but also exist in high-income countries, particularly in urban and rural areas. Methods: This article describes “Disparities in Access to Care”—held within the Social Injustice Symposium at the 2020 American Pediatric Surgical Association (APSA) Annual Meeting. Results: This symposium outlined disparities in access to care, illustrated by examples from pediatric trauma and neonatal surgery in U.S. urban, U.S. rural, and non-U.S. global locations (LMICs). Geographic and financial challenges were common to families from the rural U.S. and LMICs. In contrast, families in U.S. urban settings generally do not face geographic barriers, but are often economically and racially diverse and many face complex societal factors leading to poor outcomes. Systemic processes must be changed to improve pediatric surgical health outcomes. Conclusion: A comprehensive health system with an equal emphasis on supportive care and surgery is required in all settings. Global collaboration and partnerships can provide an avenue for advocacy and strategic innovation to improve quality of care. Level of evidence: Ⅴ

    DOI: 10.1016/j.jpedsurg.2022.03.024

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

    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   84 巻 ( 4 ) 頁: 716 - 722   2022年11月

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    記述言語:英語   出版者・発行元: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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  51. 特集 小児外科を取り巻く最新テクノロジー Hirschsprung病に対する機械学習を用いた病理診断支援システムの開発

    天野 日出, 木村 和恵, 今井 佑太, 加藤 竜司, 中澤 温子, 城田 千代栄, 滝本 愛太朗, 住田 亙, 牧田 智, 岡本 眞宗, 安井 昭洋, 高田 瞬也, 中川 洋一, 加藤 大幾, 檜 顕成, 内田 広夫

    小児外科   54 巻 ( 10 ) 頁: 1007 - 1011   2022年10月

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    出版者・発行元:東京医学社  

    DOI: 10.24479/ps.0000000254

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  52. PERSISTENT CHOLESTASIS AFTER KASAI PORTOENTEROSTOMY PREDICTS PORTAL HYPERTENSION IN NATIVE LIVER SURVIVORS OF BILIARY ATRESIA - RESULT FROM A LARGE COHORT MULTICENTRE ANALYSIS

    Chung, PHY; Harumatsu, T; Nakagawa, Y; Tsuboi, K; Chan, EKW; Leung, MWY; Yeung, F; Muto, M; Kawano, T; Amano, H; Shirota, C; Nakamra, H; Koga, H; Miyano, G; Ieiri, S; Uchida, H; Yamataka, A; Wong, KKY

    HEPATOLOGY   76 巻   頁: S1528 - S1529   2022年10月

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  53. Laparoscopic definitive surgery for congenital biliary dilatation with aggressive hilar bile ductoplasty and complete resection of the intrapancreatic bile duct in pediatric patients is safe and effective, comparable to open surgery

    Tainaka, T; Shirota, C; Hinoki, A; Sumida, W; Yokota, K; Makita, S; Amano, H; Tanaka, Y; Uchida, H

    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES   36 巻 ( 10 ) 頁: 7352 - 7359   2022年10月

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    記述言語:英語   出版者・発行元:Surgical Endoscopy  

    Background: After surgery for congenital biliary dilatation (CBD), hilar and hepatic bile duct stenosis and intrapancreatic bile duct remnants can cause many postoperative complications. We investigated the efficacy of laparoscopic surgery with aggressive bile ductoplasty and complete excision of the intrapancreatic bile duct in CBD patients compared to open surgery. Methods: Pediatric patients who underwent surgery for CBD at our institution between 2006 and 2020 were divided into two groups: laparoscopic surgery (Lap group) and open surgery (Op group). Surgical outcomes were compared between the two groups. Results: We enrolled 160 patients (85 in the Lap group and 75 in the Op group). Hilar bile ductoplasty was performed in 52 (61%) patients from the Lap group and 40 (53%) patients from the Op group. The operative time was significantly longer, the amount of blood loss was significantly lower, and the length of hospital stay was significantly shorter in the Lap group than in the Op group. Postoperative early and late complications occurred at a similarly low rate in both groups. When the surgical outcomes were compared between the group who underwent laparoscopic bile ductoplasty and the group that did not, postoperative early and late complications occurred similarly in both groups. Conclusions: Laparoscopic surgery for CBD with aggressive hilar bile ductoplasty and complete excision of the intrapancreatic bile duct is safe and effective, comparable to open surgery. However, it is necessary to verify whether long-term occurrence of hepatolithiasis similar to open definitive surgery can be obtained in the future.

    DOI: 10.1007/s00464-022-09132-x

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  54. 特集 先天性胆道拡張症up-to-date 腹腔鏡下先天性胆道拡張症根治術中に膵管損傷した2例

    加藤 大幾, 檜 顕成, 城田 千代栄, 住田 亙, 牧田 智, 天野 日出, 岡本 眞宗, 尾形 誠弥, 滝本 愛太朗, 高田 瞬也, 中川 洋一, 合田 陽祐, 内田 広夫

    小児外科   54 巻 ( 9 ) 頁: 924 - 927   2022年9月

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    出版者・発行元:東京医学社  

    DOI: 10.24479/ps.0000000238

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  55. Thoracoscopic posterior tracheopexy during primary esophageal atresia repair ameliorate tracheomalacia in neonates: a single-center retrospective comparative cohort study Open Access

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

    BMC SURGERY   22 巻 ( 1 ) 頁: 285   2022年7月

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    記述言語:英語   出版者・発行元:BMC Surgery  

    Background: Esophageal atresia (EA) is often associated with tracheomalacia (TM). The severity of TM symptoms varies widely, with serious cases requiring prolonged respiratory support and surgical treatment. Although we performed thoracoscopic posterior tracheopexy (TPT) during primary EA repair to prevent or reduce the symptoms of TM, few studies have investigated the safety and effectiveness of TPT during primary EA repair. Therefore, this study aimed to evaluate the safety and efficacy of TPT in neonates. Methods: We retrospectively reviewed the records of all patients diagnosed with TM who underwent primary thoracoscopic EA repair between 2013 and 2020 at the Nagoya University Hospital. Patients were divided into two groups: TPT (TPT group) and without TPT (control group). TPT has been performed in all patients with EA complicated by TM since 2020. We compared patient backgrounds, surgical outcomes, postoperative complications, and treatment efficacy. Results: Of the 22 patients reviewed, eight were in the TPT group and 14 were in the control group. There were no statistically significant differences in the surgical outcomes between the groups (operation time: p = 0.31; blood loss: p = 0.83; time to extubation: p = 0.30; time to start enteral feeding: p = 0.19; time to start oral feeding: p = 0.43). Conversion to open thoracotomy was not performed in any case. The median operative time required for posterior tracheopexy was 10 (8–15) min. There were no statistically significant differences in postoperative complications between the groups (chylothorax: p = 0.36; leakage: p = 1.00; stricture: p = 0.53). The respiratory dependence rate 30 days postoperative (2 [25%] vs. 11 [79%], p = 0.03) and the ratio of the lateral and anterior–posterior diameter of the trachea (LAR) were significantly lower in the TPT group (1.83 [1.66–2.78] vs. 3.59 [1.80–7.70], p = 0.01). Conclusions: TPT during primary EA repair for treatment of TM significantly lowered respiratory dependence rate at 30 days postoperative without increasing the risk of postoperative complications. This study suggested that TPT could improve TM associated with EA.

    DOI: 10.1186/s12893-022-01738-1

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  56. Laparoscopic definitive surgery for choledochal cyst is performed safely and effectively in infants Open Access

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

    JOURNAL OF MINIMAL ACCESS SURGERY   18 巻 ( 3 ) 頁: 372 - 377   2022年7月

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

    Background: Laparoscopic definitive surgery for choledochal cyst (CC) in infants requires advanced skills because of their small size. If patients with a prenatal diagnosis of CC have any biliary symptoms, they need semi-emergency definitive surgery. This study aimed to estimate whether laparoscopic definitive surgery for CC can be performed safely and effectively in infants, especially when emergency surgery is required. Patients and Methods: From January 2006 to December 2019, 21 patients under 1 year of age underwent laparoscopically or open definitive surgery, and 16 patients aged 3-5 years underwent laparoscopic surgery for CC at our institution. In cases of prenatal diagnosis, elective surgery (EL) was performed at about 6 months of age for patients with no biliary symptoms; the semi-emergency surgery (EM) was performed when patients had any biliary symptoms. Surgical outcomes were retrospectively compared between the Lap <1 y and Op <1 y groups and between the Lap <1 y and Lap 3-5 y groups. In addition, the surgical outcomes of those who underwent EM were also evaluated. Results: Operative time was significantly longer, and blood loss was significantly lower in the Lap <1 y group than in the Op <1 y group. All surgical outcomes were similar between the Lap <1 y and Lap 3-5 y groups and between the EM and EL groups. Conclusion: Laparoscopic definitive surgery for CC in infants under 1 year of age is safe and feasible. Even semi-emergency laparoscopic surgery can be performed safely and effectively in small infants.

    DOI: 10.4103/jmas.JMAS_98_21

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

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

    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES   36 巻 ( 6 ) 頁: 4328 - 4332   2022年6月

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    記述言語:英語   出版者・発行元:Surgical Endoscopy  

    Background: Most studies reporting the outcomes of laparoscopic ovarian prolapsed hernia operations with large sample sizes are based on intracorporeal closure, while studies on extraperitoneal closure have limited sample sizes. We proactively used the single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) technique and obtained favorable outcomes, which we report in this paper. Methods: We retrospectively reviewed patients who had undergone laparoscopic surgery for inguinal hernia at our institution. They were retrospectively classified into two groups based on the pre- or intraoperative diagnosis of hernia with a prolapsed ovary, namely the prolapse group and the non-prolapse group, respectively. The data were statistically analyzed and p < 0.05 was considered statistically significant. Results: A total of 771 subjects underwent SILPEC during the study period, including 400 girls. Among them, 63 girls were diagnosed with an ovarian prolapsed hernia. SILPEC was successfully performed through a single port in all cases, with a single exception, in whom the forceps was inserted directly through the right lower quadrant to pull up the ovary. The duration of surgery in the prolapse group was not higher than that in the non-prolapse group. During the SILPEC surgery, the ovaries were successfully reverted into the abdominal cavity by external compression of the inguinal area alone in 38 of the 63 patients. In the remaining 25 cases, the ovaries were reverted into the abdominal cavity by external compression of the inguinal area and traction of the round ligament with forceps. None of these cases failed to return to the ovaries. Conclusion: Our study results indicate that SILPEC may be performed safely for the treatment of ovarian prolapsed inguinal hernia. Since the ovary and fallopian tube are close to the internal inguinal ring due to the short round ligament, the procedure requires careful suturing with traction of the round ligament.

    DOI: 10.1007/s00464-021-08777-4

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  58. METABOLOMICS OF URINARY METABOLITES IN CHILDHOOD RHABDOMYOSARCOMA TO DISCOVER NOVEL BIOMARKERS

    Nakano, S; Uchida, H; Amano, H; Narita, A; Abe, M; Ishigaki, T; Sakairi, M; Shirota, C; Sumida, W; Makita, S; Takimoto, A; Okamoto, M; Yasui, A; Takada, S; Nakagawa, Y; Terui, Y; Sunagawa, M; Takahashi, Y; Osawa, T; Hinoki, A

    PEDIATRIC BLOOD & CANCER   69 巻   2022年6月

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  59. Patients with gastric volvulus recurrence have high incidence of wandering spleen requiring laparoscopic gastropexy and splenopexy Open Access

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

    PEDIATRIC SURGERY INTERNATIONAL   38 巻 ( 6 ) 頁: 875 - 881   2022年6月

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

    Purpose: Though gastric volvulus in neonates and infants resolves by conservative therapy and aging, some cases require surgical intervention. This study aimed to review the cases of gastric volvulus requiring surgical intervention and evaluate their characteristics. Methods: We retrospectively reviewed gastric volvulus cases requiring surgical intervention. Surgical indication was persistent acute gastric volvulus and repeated hospitalization for gastric volvulus. We evaluated the characteristics of those cases requiring surgical intervention and the surgical results of laparoscopic gastropexy. Results: The median age of patients included was 4 years (range: 1–6 years). All eight cases of gastric volvulus requiring sugery had congenital spleen diseases. Six of the eight cases suffered from a wandering spleen, while two cases presented with situs inversus with asplenia. Both splenopexy (preperitoneal distension balloon [PDB] or blunt separaion methods) and gastropexy were performed in cases with wandering spleen. No postoperative complications were reported in any of the eight cases, except the recurrence of gastric volvulus due to suture shedding in one case. Conclusion: Laparoscopic gastropexy for gastric volvulus and splenopexy for cases concomitant with wandering spleen were found to be effective surgical approaches. Both PDB and blunt separation methods for making extraperitoneal pockets for the spleen were employed successfully.

    DOI: 10.1007/s00383-022-05125-y

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  60. Utility of endoscopic retrograde cholangiopancreatography in management of pediatric pancreaticobiliary disease Open Access

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

    BMC PEDIATRICS   22 巻 ( 1 ) 頁: 134   2022年3月

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    記述言語:英語   出版者・発行元:BMC Pediatrics  

    Background: The purpose of this study was to evaluate the utility of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients with pancreaticobiliary diseases. Methods: A retrospective review was performed on patients who underwent ERCP for the treatment of biliary tract disease and detailed examination of pancreatitis at our institution from January 1999 to December 2020. Results: ERCP was performed for congenital biliary dilatation (CBD) (n = 42), choledocholithiasis (n = 9), common bile duct stenosis (n = 1), and several types of pancreatitis (n = 13). The only severe complication of ERCP was common bile duct injury. Three (5.8%) of 52 biliary diseases failed to be treated by ERCP. All patients with pancreatic disease were correctly diagnosed and treated. Conclusions: Endoscopic biliary drainage with a temporary stent was adequate for symptomatic relief in CBD. Stenting of the pancreatic duct was useful for improving the angulation and drainage of the pancreatic duct. ERCP was useful for understanding the anatomy of the pancreatic duct and revealing potential treatments. Therefore, ERCP and transendoscopic therapy are sufficiently feasible in pediatric patients and should be actively introduced for the investigation and treatment of pancreaticobiliary diseases.

    DOI: 10.1186/s12887-022-03207-3

    Open Access

    Web of Science

    Scopus

    PubMed

  61. Safety and feasibility of primary radical surgery for meconium peritonitis considering patients' general condition and perioperative findings Open Access

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

    NAGOYA JOURNAL OF MEDICAL SCIENCE   84 巻 ( 1 ) 頁: 148 - 154   2022年2月

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    記述言語:英語   出版者・発行元:Nagoya Journal of Medical Science  

    We reviewed the outcomes of meconium peritonitis and evaluated the safety and feasibility of primary radical surgery for meconium peritonitis. A total of 21 cases of meconium peritonitis between 2006 and 2020 were retrospectively reviewed. The patients were classified into two groups based on the type of surgery: group I (primary radical surgery, n = 16) and group II (multistage surgery; drainage only or ileostomy, followed by elective surgery, n = 5). Patient backgrounds and surgical outcomes were compared between the two groups. The term of prenatal diagnosis, preoperative white blood cell count, and preoperative catecholamine use were not significantly different between the two groups. Group I included more mature neonates than group II (gestational age at birth, 35w1d vs 30w1d, p = 0.02; birth weight, 2.5 kg vs 1.1 kg, p < 0.01). Preoperative C-reactive protein was significantly lower in group I (0.37 mg/dL vs 2.8 mg/dL, p < 0.05). Operation time, blood loss, time to enteral feeding, and complication rates were not significantly different between the two groups. The surgical outcomes of primary radical surgery were comparable to those of multistage surgery, although the patients’ backgrounds were different. Our strategy of selecting one-stage or multiple-stage surgery for treatment of meconium peritonitis, depending on the patient’s general condition and degree of intestinal ischemia, was reasonable.

    DOI: 10.18999/nagjms.84.1.148

    Open Access

    Web of Science

    Scopus

    PubMed

  62. Laparoscopic Kasai portoenterostomy can be a standard surgical procedure for treatment of biliary atresia Open Access

    Shirota, C; Hinoki, A; Tainaka, T; Sumida, W; Kinoshita, F; Yokota, K; Makita, S; Amano, H; Nakagawa, Y; Uchida, H

    WORLD JOURNAL OF GASTROINTESTINAL SURGERY   14 巻 ( 1 ) 頁: 56 - 63   2022年1月

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  63. 多発肝内胆管狭窄を伴う先天性胆道拡張症術後難治性肝内結石の1例 Open Access

    牧田 智, 内田 広夫, 檜 顕成, 城田 千代栄, 住田 亙, 天野 日出, 岡本 眞宗, 尾形 誠弥, 滝本 愛太朗, 高田 瞬也, 中川 洋一, 加藤 大幾, 合田 陽祐

    日本膵・胆管合流異常研究会プロシーディングス   45 巻 ( 0 ) 頁: 74 - 75   2022年

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    記述言語:日本語   出版者・発行元:日本膵・胆管合流異常研究会  

    DOI: 10.34410/jspbm.45.0_74

    Open Access

    CiNii Research

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科研費 6

  1. 網羅的遺伝子解析による胆道閉鎖症の病態解明と新たな治療薬の開発

    研究課題/研究課題番号:25K11860  2025年4月 - 2028年3月

    科学研究費助成事業  基盤研究(C)

    田井中 貴久, 城田 千代栄, 牧田 智, 内田 広夫, 天野 日出, 中川 洋一, 檜 顕成

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    担当区分:研究分担者 

    胆道閉鎖症は胆汁鬱滞を引き起こす一つの症候群であり、多因子要因であると推定されている。従来の研究ではいくつか関連が示唆される遺伝子変異が特定されているが、本邦におけるデータを乏しい。胆道閉鎖症の発症機序は人種、地域により異なることが考えられるため、本邦の遺伝的要因・エピジェネティクスの解明は必須である。本研究では、特定の遺伝子変異を特定して、これに基づく診断法および治療法の開発を進めること、およびエピジェネティクス(遺伝子発現変化)に着目して、発症病態の解明と新規治療薬の開発を進める。

  2. AICT画像解析による腸管壊死/腸管穿孔補助診断アルゴリズム開発への挑戦

    研究課題/研究課題番号:24K22377  2024年6月 - 2027年3月

    科学研究費助成事業  挑戦的研究(萌芽)

    内田 広夫, 森 健策, 城田 千代栄, 牧田 智, 田井中 貴久, 小田 昌宏, 天野 日出, 鈴木 耕次郎, 檜 顕成

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    担当区分:研究分担者 

    今回の研究では、CT画像からの腸管アノテーションを10000枚以上行い、より高精度に腸管の走行を認識し、腸閉塞の診断を正確に行うAI画像診断システムを作成する。腸閉塞を対象疾患としたCT読影試験を行い、このシステムを使用した医師が有意に早く正確に腸閉塞の部位を同定できることを明らかにする。次に腸管壊死・腸管穿孔のCT画像を10000枚以上アノテーションして、「正常腸管」を認識するシステムと紐づけ、腸管壊死が「正常腸管と異なる」、腸管穿孔によるfree airが「正常腸管“外”の所見」であることを明らかにすることで、腸管壊死および腸管穿孔をAI画像診断するシステムを完成させる。

  3. 新規神経芽腫マーカー(CTN/VLA)の有効性(診断率・悪性度予測)検証と病態解明

    研究課題/研究課題番号:24K11018  2024年4月 - 2027年3月

    科学研究費助成事業  基盤研究(C)

    檜 顕成, 内田 広夫, 高橋 義行, 成田 敦, 大澤 毅, 城田 千代栄, 田井中 貴久, 天野 日出, 牧田 智, 横田 一樹

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    担当区分:研究分担者 

    CTN/VLAは既存マーカーと比較し悪性度を予測できる点で臨床的に有効なマーカーになり得る可能性があり、世界的にもCTNとMYC変異との強い相関が注目されつつある。特に最近の研究においてCTNについては、腫瘍細胞フェロトーシスと脂質過酸化(CTN蓄積)、MYC変異との関与から、神経芽腫の自然退縮(細胞死)との関連が示唆され、フェロトーシスの調節が神経芽腫の将来の治療に繋がると考えられている。
    本研究ではMYC遺伝子増幅神経芽腫サンプル/非増幅サンプル/健常コントロールサンプルにおいてCTN/VLAの有効性(診断率・腫瘍悪性度予測)の検証を行う。

  4. 小児外科手術動画の機械学習とAI画像解析によるリアルタイム手術手技評価法の開発

    研究課題/研究課題番号:24K15206  2024年4月 - 2027年3月

    科学研究費助成事業  基盤研究(C)

    安井 昭洋, 出家 亨一, 森 健策, 城田 千代栄, 牧田 智, 田井中 貴久, 小田 昌宏, 内田 広夫, 天野 日出, 檜 顕成

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    担当区分:研究分担者 

    小児内視鏡外科手術の喫緊の課題として、繊細で愛護的な高度な手術スキルを要するのにも関わらず、対象が希少疾患のため、多くの小児外科医において修練の環境が絶対的に不足していることが挙げられる。そこで、off-the-job-trainingを充実すべく、AI画像解析の技術を用いて、修練者に自己の手術手技を客観的に速やかにfeedbackできるシステムが必要だと考えた。本研究では、高難度手術対象となる希少疾患の練習モデルを用いた手技を自動評価するシステムを構築し、さらにはトレーニングツールとしてのその有効性を検証することを目的とする。

  5. 新規尿中バイオマーカーを用いた神経芽腫のスクリーニングと悪性度予測法の開発

    研究課題/研究課題番号:24K18880  2024年4月 - 2027年3月

    科学研究費助成事業  若手研究

    天野 日出

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    担当区分:研究代表者 

    配分額:4810000円 ( 直接経費:3700000円 、 間接経費:1110000円 )

    神経芽腫のより高精度な診断および悪性度予測のため、既存の診断マーカーであるHomovanillic acid (HVA)と Vanillylmandelic acid (VMA)に、新規の3-Methoxytyramine (3MT), 3-Methoxytyramine sulfate (MTS), Vanillactic acid(VLA)を加えた5種のカテコラミン代謝産物の尿中濃度を、高選択的かつ高感度に測定可能な液体クロマトグラフィー質量分析計 (Liquid Chromatography-Mass Spectrometry: LC-MS)を用いて同時定量する方法を確立し、実用化を目指す。

  6. チロシン系代謝物マーカーによる神経芽腫MYC遺伝子増幅判別モデルの改良と検証

    研究課題/研究課題番号:23K07308  2023年4月 - 2026年3月

    科学研究費助成事業  基盤研究(C)

    牧田 智, 城田 千代栄, 成田 敦, 田井中 貴久, 内田 広夫, 高橋 義行, 天野 日出, 大澤 毅, 住田 亙, 檜 顕成

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    担当区分:研究分担者 

    尿中代謝物の網羅解析を行い、悪性度に関与する代謝物(3-Methoxytyramine sulfate(MTS)、Vanillactic acid(VLA)、等)を特定し、その代謝物を用いて“尿中代謝物によるMYC遺伝子増幅神経芽腫検査法”を開発した。本研究では、新たにMYC遺伝子増幅神経芽腫サンプル、非増幅神経芽腫サンプル、健常コントロールサンプルを収集解析し、これらテストサンプルによりMYC遺伝子増幅神経芽腫検査法(トレーニングサンプル)を改良し、その汎用性を検討する。
    神経芽腫は脳腫瘍を除いた小児期発症の固形腫瘍のなかで最も頻度が高い。
    更に高リスク神経芽腫の5年無増悪生存率は30-40%と予後不良で小児がんによる死亡原因第2位である。一方で神経芽腫には自然退縮(4S)する症例も見られ、その複雑な病態の為に以前から診断治療に難渋している。化学療法が進歩しても、未だに患児の予後に寄与する診断治療の新たなブレークスルーを認めていない。
    神経芽腫の悪性度や予後及び治療はMYC遺伝子増幅の有無に左右されるが、受診時に簡便にMYC遺伝子増幅の有無を予測できるマーカーが存在しない。そこで申請者らは、尿中代謝物の網羅解析(高リスク9症例/中間リスク5症例/低リスク4症例/健常コントロール110症例)を行い、治療前リスクに応じてランダムフォレスト解析を行う事で悪性度に関与する代謝物(3-Methoxytyramine sulfate(MTS)、Vanillactic acid(VLA)等)を特定した。次いで、予備実験において神経芽腫33例 健常児78例の尿中代謝物(HVA/VMA/MTS/VLA/MTR)の定量値からMYC遺伝子増幅神経芽腫4例と非増幅神経芽腫29例を判別できる判別モデルを作成した。
    これら新規代謝物の定量結果を用いて診断早期にMYC遺伝子増幅の有無を予測するための“尿中代謝物によるMYC遺伝子増幅神経芽腫検査法”の汎用性を検討するとともに、MYCと関連性が示唆されているcystathionine(CTN)についてMYC遺伝子との関連を探索する。
    現在、順調に尿サンプル収集(神経芽腫/健常コントロール尿サンプル 約30サンプル収集済み)している。それらの尿サンプルを用いてHVA/VMA及び新規代謝物(3-Methoxytyramine sulfate(MTS)、Vanillactic acid(VLA)、3-Methoxythyrosine(MTR))の正常値及び基準値を検証中である。同時にMYCとの関連が示唆されているcystathionine(CTN)について定量解析を進めている。本研究は予定通りに進展している。
    引き続き、サンプル収集、マーカー定量、解析を進めると同時に、判別モデルの改良(MYC遺伝子増幅神経芽腫10例:各2例~4例/年)を行い、“尿中代謝物によるMYC遺伝子増幅神経芽腫検査法”の汎用性を検証する。

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