Language：English  

DOI： 10.1186/s40792-023-01679-8

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

Language：English  

DOI： 10.4103/jmas.jmas_10_23

PubMed

Publisher：東京医学社  

DOI： 10.24479/ps.0000000445

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

Purpose: Severely neurologically impaired patients sometimes require anti-reflux surgery with preceding gastrostomy. We apply a traction technique for laparoscopic fundoplication (LF) without gastrostomy takedown (GTD) in such cases. We conducted a multicenter review to assess the feasibility of our approach. Materials and Methods: In brief, the traction technique involves left-lateral-traction of the stomach body, right-lateral-traction of the round ligament of the liver, and elevation of the left liver lobe to create a sufficient field for manipulating the forceps. Patients who underwent LF with Nissen's procedures in 2010-2022 were retrospectively reviewed. Data were analyzed by a one-way analysis of variance. Results: The operative approaches included the traction technique (n = 16; Group 1), GTD and reconstruction (n = 5; Group 2), and LF followed by gastrostomy (n = 92; Group 3). In comparison with Group 1, significant differences were only found in pneumoperitoneum time (Group 1 versus Group 2 versus Group 3: 174.4 minutes versus 250.4 minutes versus 179.5 minutes; P = .0179). Operating time (222.7 minutes versus 303.0 minutes versus 239.7 minutes; P = .0743), duration to full-strength enteral nutrition (10.4 days versus 17.2 days versus 11.0 days; P = .0806), and length of hospital stay (17.2 days versus 31.0 days versus 18.5 days; P = .3247) were equivalent. No re-fundoplication was required in Group 1. Conclusion: The traction technique secures the operative quality and outcome of LF without GTD.

DOI： 10.1089/lap.2022.0576

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PubMed

Publisher：東京医学社  

DOI： 10.24479/pm.0000000804

Language：Japanese   Publisher：Pediatrics International  

DOI： 10.1111/ped.15579

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PubMed

Language：Japanese   Publisher：Surgery Today  

Purpose: We compared the clinical features of patients with biliary atresia (BA) associated with a bleeding tendency (BT) at the time of the diagnosis with those of patients without a bleeding tendency (NBT). Methods: The patients’ background characteristics, age in days at the first visit, Kasai portoenterostomy (KPE), and postoperative course were retrospectively analyzed. Results: Nine of the 93 BA patients (9.7%) showed a BT, including 7 with intracranial hemorrhaging (ICH), 1 with gastrointestinal bleeding, and 1 with a prothrombin time (PT) of 0%. The age at the first visit was 62 ± 12 days old for BT patients and 53 ± 27 days old for NBT patients (p = 0.4); the age at KPE was 77 ± 9 days old for BT patients and 65 ± 24 days old for NBT patients (p = 0.2); the time from the first visit to surgery was 13 ± 7 days for BT patients and 11 ± 10 days for NBT patients (p = 0.5); and the native liver survival rate was 56% for BT patients and 58% for NBT patients (p = 1), with no significant difference in any of the parameters. The neurological outcomes of survivors of ICH were favorable. Conclusions: Appropriate BT correction allowed early KPE even after ICH, resulting in native liver survival rates comparable to those of NBT patients without significant neurological complications.

DOI： 10.1007/s00595-023-02744-3

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PubMed

Language：Japanese   Publisher：Frontiers in Pediatrics  

Near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has gained popularity in pediatric surgery as it has in general surgery. In addition, a water-jet dissector (WJD) has been successfully introduced in adult hepatic surgery. Tissue structures are dissected selectively and gently by the WJD. However, there have been no reports of hepatic resection for pediatric patients using a WJD. We applied NIR fluorescence imaging with ICG to visualize the resection line of the liver and used a WJD for liver parenchyma dissection in pediatric hepatoblastoma. The patient was a 3-year-old girl with a large liver tumor. Enhanced computed tomography revealed a liver tumor (maximum diameter: 120 mm) in the right lobe and three small lung metastases. The liver tumor was diagnosed as hepatoblastoma (PRETEXT 2) based on an open biopsy. We performed right hepatectomy after neoadjuvant chemotherapy. The right lobe was mobilized from the diaphragm, and then intraoperative ultrasound was performed to detect the localization of the tumor and its proximity to the vascular structures. We detected the right hepatic artery (RHA), right portal vein (RPV), and right hepatic vein (RHV). The middle hepatic vein was not involved. After ligation of the RHA and RPV to selectively control the right lobe inflow, ICG was administered intravenously and observed by an NIR endoscope. The resection line was clearly visualized by overlaying images in comparison to conventional demarcation line detection. Then, we used a WJD to dissect the parenchyma. Small vessels were divided from parenchymal tissue and were clearly visible. We resected them after clamping with metal clips. Finally, the RHV was transected by a linear stapler, and right hepatectomy was completed with 25 ml of blood loss. There was no postoperative hemorrhage. We performed hepaticojejunostomy because of stricture of the common bile duct on postoperative day 302. The patient was discharged after adjuvant chemotherapy. NIR imaging clearly showed the resection line. The WJD automatically separated, and thus made visible, the more resistant duct and vessel structures from the parenchyma. The combined use of NIR imaging and WJD was useful for pediatric hepatectomy.

DOI： 10.3389/fped.2023.1221596

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PubMed

Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

Purpose: The intravenous administration of acetaminophen (IAA) has become standard postoperative analgesic management for pediatric surgery. However, the most effective methods of IAA for postoperative acute appendicitis are unclear. We evaluated the analgesic efficacy of scheduled IAA vs on-demand IAA for postoperative acute appendicitis. Methods: Ninety-four patients who underwent laparoscopic appendectomy in our institution between January 2017 and December 2020 were enrolled. The patients were divided into two groups based on the postoperative pain control protocols. The scheduled IAA group (SA group, n = 42) was managed by scheduled IAA and additional on-demand use of pentazocine as rescue therapy. The on-demand IAA group (ODA group, n = 52) was managed by on-demand IAA as the first choice, with pentazocine as the second choice for pain control. The patients' background characteristics, operative results and postoperative outcomes were reviewed. Results: The number of times pain complaints were made per patient per day (NPPD) on postoperative days (POD) 1 and 2 was significantly lower in the SA group than in the ODA group (POD 1; 1.12 ± 1.21 vs 2.62 ± 1.89, p < 0.01; POD 2; 0.45 ± 0.86 vs. 1.31 ± 1.69, p < 0.01). According to pathological findings, NPPD was lower in the SA group than in the ODA group for both phlegmonous appendicitis (0.71 ± 1.01 vs. 2.10 ± 2.13, P <.05) and gangrenous appendicitis (1.33 ± 1.50 vs 2.94 ± 1.68, P <.01). On POD 2, the incidence of gangrenous appendicitis was significantly lower in the SA group than in the ODA group (0.57 ± 0.93 vs 1.78 ± 1.86, P <.01). Conclusions: Scheduled IAA may have favorable efficacy for postoperative pain control after emergency surgery for acute appendicitis in pediatric patients.

DOI： 10.1111/ases.13068

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PubMed

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

症例は13歳男児で、腹痛と触知可能な腫瘤を呈し、造影CTで上行結腸に浸潤する最大径13cmの巨大腹部腫瘍を認め、バリウム注腸にて上行結腸の重度狭窄がみられた。PET-CTで多発性腹部リンパ節転移が検出され、MRIでは腫瘍は大網に起源し、T1強調像にて軽度低信号、T2強調像にて軽度高信号を呈していた。大網に生じる線維形成性小円形細胞腫瘍が考えられ、鑑別疾患としてリンパ腫、結核性腹膜炎が挙げられた。腹腔鏡下手術を行うこととし、腹腔内に進入すると右側腹部に大網を覆う巨大腫瘍を確認し、漿液性腹水がみられたが肉眼的に腹膜播種は認められなかった。腹水を採取すると悪性細胞は検出されず、転移が疑われるリンパ節の腫大を同定、巨大腫瘍は炎症性変化をきたして腹膜に癒着しており、超音波デバイスを用いて慎重に切離した。続いてリンパ節4Dと6を大網と右胃大網動脈から切離し、リンパ節202は回結腸動静脈を結紮後に切除した。さらに、回腸末端近位部に沿って回腸を15cmにわたって切離し、巨大腫瘍と横行結腸に対する摘出術を施行した。手術時間は5時間47分、出血量は20mLであった。術後の病理所見、免疫組織化学染色の結果から11q異常を伴うBurkitt様リンパ腫と確定診断を下した。術後経過は良好で、4日目に経口摂取を開始し、腫瘍融解症候群の症状なく寛解が得られている。

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

小児の腹腔鏡下虫垂切除術にみられる術後痛に対するアセトアミノフェン静注の予定投与とオンデマンド投与の有効性を比較検討した。腹腔鏡下虫垂切除術を施行された小児患者94例を静注アセトアミノフェン予定投与群(SA群)42例(平均9.31±2.31歳)とオンデマンド投与群(ODA群)52例(平均9.21±2.89歳)に分類し、両群の患者背景、手術成績、術後アウトカムを比較した。体重、白血球数、CRP、AST値、ALT値、虫垂サイズに関してSA群とODA群との間に有意差はなかった。手術時間、気腹時間、癒着の有無、病理学的診断、術後摂食開始までの期間、抗生剤投与、術後在院期間にも有意な群間差はなく、術後合併症の発症はみられなかった。術後痛に関して、術翌日、2日後ともに疼痛の訴えはSA群の方がODA群より有意に少なく、蜂巣炎性虫垂炎、壊疽性虫垂炎のいずれでも術翌日はSA群の方が疼痛を訴える患児は少なかった。このほか、静注アセトアミノフェンの投与量はSA群の方が有意に多く、救済鎮痛薬としてのペンタゾシンの投与回数に有意な群間差はなかった。小児の腹腔鏡下虫垂切除術後の疼痛に対して、静注アセトアミノフェンの予定投与は有用であることが示された。

Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

We herein report a 13-year-old boy with a chief complaint of abdominal pain and a palpable mass. Contrast-enhanced computed tomography (CT) scan showed an abdominal bulky tumor involving the ascending colon causing severe stenosis, with multiple abdominal lymph node metastases detected by positron emission tomography (PET)-CT. Laparoscopic radical resection with right hemicolectomy and lymph node dissection was planned. The bulky tumor was dissected from the retroperitoneum and resected en bloc with the right-side colon and omentum. The preoperatively detected metastatic lymph nodes were resected along with the tumor. A 6-cm longitudinal umbilical incision was made, and the huge tumor was removed, with functional end-to-end anastomosis performed for intestinal reconstruction. The pathological diagnosis was Burkitt-like lymphoma with 11q aberration. The postoperative course was uneventful. Laparoscopy-assisted extirpation is feasible for pediatric solid tumors involving other organs, but indications and procedures should be carefully determined based on preoperative imaging, intraoperative findings and surgeon's skills.

DOI： 10.1111/ases.13081

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PubMed

Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

Introduction: Management of neonates with long gap esophageal atresia (LGEA) is one of the most challenging situations facing pediatric surgeons. Delayed anastomosis after internal traction for esophageal lengthening was reported as a useful technique for long gap cases. Additionally, the use of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has gained popularity in pediatric surgery, especially for blood perfusion validation. We report a novel technique for safe and secure anastomosis for LGEA in the neonatal period using internal traction and ICG-guided NIR fluorescence. Patient and Surgical Technique: A pregnant woman with polyhydramnios was admitted to the department of obstetrics in our hospital. At 29 weeks of gestation, ultrasound showed mild polyhydramnios and absence of the fetal stomach. A male neonate was born at 38 weeks of gestation with 21 trisomy. EA (Gross type A) was diagnosed based on an X-ray study that showed the absence of gastric bubble with a nasogastric tube showing the “coil-up” sign. Thoracoscopic internal traction and laparoscopic gastrostomy were performed on day 4 after birth. We confirmed the distance between the upper pouch and lower pouch on X-ray. On day 16 after birth, thoracoscopic anastomosis was performed. We successfully performed esophageal anastomosis without tearing the esophageal wall. Blood perfusion of the upper and lower pouch was validated after anastomosis using ICG-guided NIR fluorescence. Conclusion: Delayed anastomosis for LGEA in the neonatal period using internal traction and ICG-guided NIR fluorescence is safe and feasible.

DOI： 10.1111/ases.13098

Scopus

PubMed

Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

Purpose: In this study, we used a near-infrared ray catheter (NIRC) to visualize the urethral line. We herein report our intraoperative visualization technique of the urethra using an illuminating catheter in laparoscopy-assisted anorectoplasty (LAARP) for imperforated anus. Patient and surgical technique: A 3.0-kg term male neonate with anorectal malformation was delivered. An invertogram revealed the type as intermediate. Transverse colostomy was performed at the left upper abdomen. A recto-bulbar urethral fistula (RBUF) was diagnosed via distal colostogram and voiding cystourethrogram. LAARP was planned at 6 months of age. We performed the operation with four trocars. A 45° 5-mm scope was used to clearly view the deep pelvic space. Before starting rectal dissection, a 6-Fr pig-tail-type NIRC was inserted through the external opening of the urethra to visualize the urethra during the laparoscopic procedure. The catheter tip was placed in the bladder, and excretion of urine was maintained through the NIRC during the procedures. While dissecting the deep pelvic space between the posterior wall of the urethra and anterior wall of the rectum, the exact line of the urethra was clearly confirmed by overlay images of the NIRC. The RBUF was dissected safely using this innovative image-guided technique. Anoplasty was performed between the rectal stump and perineal skin. The postoperative course was uneventful. Oral intake was started on postoperative day 1. Postoperative dynamic urography showed no complications. Conclusion: An NIRC is useful for detecting the urethra during LAARP.

DOI： 10.1111/ases.13061

Scopus

PubMed

Language：English  

DOI： 10.1186/s40792-022-01535-1

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

Language：Japanese   Publisher：Pediatric Surgery International  

Purpose: Representative neonatal surgical diseases are often complicated by congenital heart disease (CHD). We reviewed our decade of experience from the perspective of the prognosis and report on the management of infants with CHD. Methods: Cases with and without CHD between 2011 and 2020 were retrospectively compared. Qualitative data were analyzed using a chi-square test with Yates' correction, and quantitative data were compared using Student's t-test. Results: Of the 275 neonatal surgical cases, 36 had CHD (13.1%). Ventricular septal defect was the most common cardiac anomaly, followed by atrial septal defect. Esophageal atresia showed the highest complication rate of CHD (43.8%, 14/32) followed by duodenal atresia (38.5%, 10/26). The mortality rates of patients with and without CHD (22.2% [8/36] vs. 1.3% [3/239]) were significantly different (χ2 = 30.6, p < 0.0001). Of the eight deaths with CHD, six patients had cyanotic complex CHD. Notably, four of these patients died from progression of inappropriate hemodynamics in the remote period after definitive non-cardiac surgery. Conclusion: Considering its high-mortality, the presence of CHD, especially cyanotic heart disease, is an important issue to consider in the treatment of neonatal surgical diseases. Pediatric surgeons should be alert for changes in hemodynamics after surgery, as these may affect mortality.

DOI： 10.1007/s00383-022-05178-z

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PubMed

Language：Japanese   Publisher：Journal of Pediatric Surgery  

Purpose: Short bowel syndrome (SBS) patients require total parenteral nutrition (TPN) following massive small bowel resection (SBR), which may cause intestinal failure-associated liver disease (IFALD), a life-threatening complication. Hepatocyte growth factor (HGF) acts as a potent hepatocyte mitogen with anti inflammatory and antioxidant actions. The present study evaluated the effect of recombinant human HGF (rh-HGF) on SBR and subsequent IFALD using a parentally fed rat model of SBS. Methods: Rats underwent jugular vein catheterization for continuous TPN and 90% SBR. They were divided into 2 groups: TPN alone (SBS/TPN group: n = 7) or TPN plus the intravenous administration of rh-HGF (0.3 mg/kg/day) (SBS/TPN+HGF group: n = 7). On day 7, their tissues and stool were harvested to evaluate the effects of HGF. Results: Regarding the histological findings, based on the nonalcoholic fatty liver disease (NAFLD) activity score, the SBS/TPN+HGF group showed significantly less hepatic steatosis and inflammatory cell infiltration than the SBS/TPN group (NAFLD activity score, 4.00 ± 1.83 vs. 1.00 ± 0.82; p < 0.01). The SBS/TPN+HGF group showed a higher expression of Farnesoid X receptor in the liver and lower expression of Toll-like receptor 4 in the ileum than the SBS/TPN group. Regarding the composition of the bacterial gut microbiota, Actinobacteria, Bacteroidetes and Proteobacteria were decreased in the SBS/TPN+HGF group compared with the SBS/TPN group. Conclusion: In our SBS with TPN rat model, rh-HGF administration had a preventive effect against hepatic steatosis and dysbiosis. rh-HGF may therefore be a potentially effective therapeutic agent for SBS and subsequent IFALD. Type of study: Experimental research.

DOI： 10.1016/j.jpedsurg.2022.02.030

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PubMed

Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

Severely neurologically impaired patients often require the creation of a gastrostomy when they develop difficulty with oral intake followed by antireflux surgery. We use a traction technique for laparoscopic fundoplication without removing the gastrostomy in such cases. Right lateral traction of the round ligament of the liver and left lateral traction of the stomach body are performed using a needle device. The left liver lobe is elevated with a liver retractor inserted via the epigastrium. This traction technique allows a sufficient surgical field for manipulating forceps to be created in cases with a gastrostomy, enabling fundoplication to be performed safely without removing the gastrostomy.

DOI： 10.1111/ases.13028

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PubMed

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

症例は42歳男性で、低酸素性脳症を原因とする脳性麻痺を呈しており、経口摂取が困難で腹腔鏡下胃瘻造設術を受けていた。胃食道逆流のために頻回な誤嚥性肺炎をきたし、腹腔鏡下噴門形成術を行った。四肢拘縮と側彎を考慮して斜仰臥位にて右尾側から手術を開始した。臍切開部より12mm Hassonトロカーを挿入し、気腹を8mmHgに設定した後に腹腔鏡を挿入、左手ポート(5mm)を右上腹部より挿入しニードルデバイスを用いて肝円索を2-0絹糸により右側方に牽引し、さらに胃体部を3-0モノフィラメント縫合糸を用いて左側方に牽引した。続いて、右手ポート(5mm)を胃瘻部に近接する左上腹部に挿入し、補助ポート(5mm)を左側方冠側の胃瘻近接部に留置、肝開創器を心窩部を介して挿入し肝左葉を挙上した。さらに横隔膜脚部を同定し腹部食道を露出後、脚部を縫合処理し、3-0ポリエステル非吸収性縫合糸を用いて被覆固定を行い、被覆した胃底中部と横隔膜右脚部を固定処理して手術を終了した。

Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

<p>We successfully treated a case of pancreatic pseudocyst caused by type IIIb pancreatic injury via laparoscopic external drainage. [Case] A 14-year-old boy presented with abdominal pain after having his upper abdomen bruised by contact with another player’s knee during a soccer match. Magnetic resonance cholangiopancreatography (MRCP) showed complete rupture of the pancreatic body, and fluid collection was detected around it. The patient was diagnosed as having type IIIb pancreatic injury based on the classification of the Japanese Society of Trauma. We selected a non-operative management approach because the patient was hemodynamically stable. However, after conservative treatment, a pancreatic pseudocyst of 3 cm diameter was found; thus, endoscopic retrograde pancreatography (ERP) was performed on the 11th day of illness. The pancreatic duct was transected at the body of the pancreas, and a pancreatic duct stent was placed into the cyst, but it fell off after three days. After that, the pancreatic pseudocyst tended to grow and increased in size from the subdiaphragm to the lower pole of the kidney. Therefore, we performed laparoscopic external drainage on the 45th day of hospitalization. After the operation, the patient showed no abdominal symptoms, and no recurrence of cysts was recognized. [Conclusion] Laparoscopic drainage of pancreatic pseudocysts can enable the observation of the entire abdominal cavity while also facilitating safe and reliable drainage. Therefore, depending on the patient condition, laparoscopic external drainage of pancreatic pseudocysts may be considered as a treatment option.</p>

DOI： 10.11164/jjsps.58.4_734

Language：Japanese   Publisher：(一社)日本小児外科学会  

今回、IIIb型膵損傷後の膵仮性嚢胞に対し、腹腔鏡下嚢胞ドレナージが奏功した1例を経験した。【症例】症例は14歳男児。サッカーの試合中に他選手の膝で上腹部を打撲後に腹痛を訴え救急搬送された。Magnetic resonance cholangiopancreatography(MRCP)では日本外傷学会分類IIIb型の膵損傷と診断した。全身状態は安定しており保存的に加療する方針とした。しかしその後に、3cm大の膵仮性嚢胞を認め、内視鏡的逆行性膵管造影を11病日に施行した。主膵管は膵体部で断裂し、膵管ステントを嚢胞内へ留置したが数日で脱落した。その後、嚢胞は横隔膜下から腎下極に及ぶまで増大したため、入院45日目に腹腔鏡下嚢胞開窓ドレナージ術を行った。術後は腹部症状や嚢胞の再発は認めず経過している。【結語】膵仮性嚢胞に対する腹腔鏡下嚢胞ドレナージは、腹腔内の観察ができ、確実なドレナージが可能である。病態に応じて膵仮性嚢胞のドレナージ法の選択肢として検討されうると考えられた。(著者抄録)

Publisher：東京医学社  

DOI： 10.24479/ps.0000000100

Language：Japanese   Publisher：(株)東京医学社  

過去5年間に当施設で入院診療を行った重症心身障碍児82人(男性56人、女性26人、平均年齢19.8歳)を対象として、便秘や呑気などの臨床症状と、処方されていた薬を後方視的に分析した。手術は95件行われており、噴門形成術、胃瘻造設術、気管切開術などの予定手術が81件、イレウス解除術などの緊急手術が14件であった。術前の栄養形態は半消化態栄養剤が67人で最も多く、成分栄養剤7人、消化態栄養剤1人、ミルク6人で経口摂取は1人のみであった。術前薬については漢方製剤を20人、刺激性下剤を20人、整腸剤を19人、塩類下剤を15人、浸透圧下剤を1人が使用していた。浣腸のみを含めて無投薬は33人であった。術前の腹部単純X線で宿便を認めたのは5人のみであったが、広範な小腸ガス貯留など呑気による影響と考えられる所見は44人で認められた。呑気症を背景にイレウスを繰り返した2症例を提示した。

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

症例は1歳8ヵ月の男児で、生後一時的に胆汁嘔吐をきたしたが症状は自然消失し、発達障害はみられなかった。1歳4ヵ月時、間欠的な胆汁嘔吐を認め、精査目的に当院を受診した。上部消化管造影検査で十二指腸球部から下部にかけての拡張がみられ、下部から水平部にかけての造影剤のうっ滞が生じていた。造影CTでは上腸間膜動脈と上腸間膜静脈(SMV)の配置に異常はみられなかったが、末梢部にてコークスクリュー徴候を認め、SMVの著明な狭窄と側副循環が検出された。以上の所見から中腸軸捻を伴う腸回転異常と診断し、腹腔鏡下手術を計画した。中腸軸捻を回盲部からの小腸トレースにより逆行性に解除し腸間膜根部を確認、腸間膜に重度の癒着が生じていたため、インドシアニングリーンによる蛍光ナビゲーション下に組織をクランプして灌流を図った。これにより安全な組織の切離が可能となり、腸間膜根部の開大を確認できた。腸管を非回転位に収納し脾彎曲部の結腸はBill法を用いて固定した。術後2日目に飲水、3日目に摂食が可能となり、5日目に退院となった。その後4ヵ月、軸捻やイレウスの再発は認めていない。

Language：Japanese   Publisher：Asian Journal of Endoscopic Surgery  

We herein report a 20-month-old boy who underwent laparoscopic Ladd's surgery. He showed intermittent bilious vomiting after birth and received a definitive diagnosis of intestinal malrotation. Laparoscopic Ladd's procedure was performed with four trocars. Midgut volvulus (180° counterclockwise) was resolved by retrogradely tracing the small intestine from the ileocecal region. After dividing Ladd's ligament, fluorescent navigation with indocyanine green was used. We decided where to dissect the mesenteries by confirming the vascular perfusion through clamping the tissue. Fibrous adhesions were gradually dissected, and it was confirmed that the mesenteric root was sufficiently broadening. Surgeons hesitate to dissect the mesenteric root in laparoscopic procedures compared with open procedures because of the narrow operative view and the risk of vascular injury. Laparoscopic Ladd's procedure using indocyanine green to confirm intestinal blood flow is safe and useful for the small working space in pediatric patients with intestinal malrotation and midgut volvulus.

DOI： 10.1111/ases.13026

Scopus

PubMed

Language：English  

DOI： 10.1186/s40792-022-01409-6

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

症例は3歳男児で、突然の腹痛を主訴に近医を受診した。ウイルス性胃腸炎と診断され、保存的治療が行われたが症状は改善しなかった。X線検査で腸管拡張とイレウスを認め、当院へ搬送された。腹部膨隆と腹部全体に圧痛を認め、特に下腹部で強い筋性防御(腹膜刺激徴候)を認めた。臨床検査で白血球数は20800/μL、C反応性蛋白質は5.79mg/dLの高値を呈した。ASTは29U/L、ALTは11U/L、総ビリルビンは0.8mg/dL、尿素窒素は8.0mg/dL、クレアチニンは0.21mg/dLであった。造影CTで構造が消化管に似た嚢胞性病変と腹水を認めた。腸管拡張またはイレウスの所見は見られなかった。消化管への血流は保持されていたため、メッケル憩室捻転の疑いで診断的腹腔鏡検査を実施した。右下腹部に黒色の管状構造を形成する嚢胞性病変が720°茎捻転していた。捻転を整復したところ、メッケル憩室捻転ではなく、消化管重複症であった。重複腸管を切除した。病理組織学的検査で切除標本は回腸壁の構成要素を有していた。術後経過は良好で、14日後に退院となった。3年後の再診で合併症は見られなかった。

Language：English   Publisher：シュプリンガー・ジャパン(株)  

単施設において、1984年4月～2017年12月に後腹膜奇形腫(RPT)の治療を行った小児患者15例(男児4例、女児11例)の治療経験を報告した。年齢は日齢6～12歳であり、15例中11例(73.3%)が1歳未満であった。すべての患者で外科的完全切除術が施行された。術中の腫瘍破裂を4例(26.7%)に、周術期の血管損傷を6例(40.0%)に認め、最終的には1例(6.7%)が腎摘出術を要した。また、手術合併症として、片側腎機能障害を3例(20.0%)に認めた。術後化学療法を施行した患者は1例のみであった。その後いずれの患者も治癒している。

Language：Japanese   Publisher：Surgery Today  

Purpose: Retroperitoneal teratomas (RPTs) are rare in infants. We report our experience of treating pediatric patients with RPTs over many years at a single institution, with the aim of developing a safe and secure operative strategy for RPTs in infants. Methods: We reviewed the medical records of patients who underwent treatment for RPTs in our institution between April, 1984 and December, 2017, to analyze their background and clinical data. The diagnosis of RPT was confirmed histologically in all patients. Results: The subjects of this retrospective analysis were 14 pediatric patients (female, n = 11; male, n = 4), ranging in age from 6 days to 12 years, 11 (73.3%) of whom were under 1 year of age. Complete surgical resection was performed in all patients. The tumor ruptured during surgery in four (26.7%) patients and perioperative vessel injuries occurred in six (40.0%) patients, resulting in nephrectomy in one (6.7%). Three (20.0%) patients suffered unilateral renal dysfunction as a surgical complication. Only one patient received postoperative chemotherapy. All patients were free of disease at the time of writing. Conclusion: Perioperative complications are not uncommon during surgery for RPTs, despite their benign nature. Preoperative imaging evaluation is important and operative management may be challenging. Because of the favorable prognosis and the frequency of adverse events in surgery, partial resection or split excision is sometimes unavoidable. Meticulous follow-up for recurrence is required for such patients.

DOI： 10.1007/s00595-021-02327-0

Scopus

PubMed

Language：English  

DOI： 10.1055/s-0042-1747913

PubMed

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2022081276

Language：English  

DOI： 10.1186/s40792-021-01298-1

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

症例は正期産で出生した男児で、肛門直腸奇形を認めた。Invertogramでは中間型であり、左上腹部に横行結腸瘻を造設し、直腸球部尿道瘻(RBUF)と診断、6ヵ月時にオープンMRIによる腹腔鏡下肛門直腸形成術を行った。手術の3週前にオープンMRIシステムを用いて骨盤底を撮像し、直腸pull-through法が施行可能であると判断した。全身麻酔下に手術を開始し、臍部に縦切開を置きトロカーを挿入、気腹を確立後に右上腹部、右下腹部および臍部左側にトロカーを追加した。骨盤神経損傷を回避する目的で直腸切離を行い、その後に縫合糸を用いてRBUFを閉鎖し、ステープラーで切離後に結紮を施した。肛門形成後にオープンMRIスキャンを実施し、pull-throughされた直腸が筋複合体中心に位置することを確認した。手術時間は420分、撮像時間は40分であった。術後経過は良好で術翌日に経口摂取が可能となり、14日目のダイナミック尿路造影では合併症はなく、15日目に退院となった。3ヵ月後、結腸造影を施行して横行結腸瘻を解除する予定である。

Language：English  

DOI： 10.1186/s40792-021-01231-6

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

3ヵ月前から心窩部痛と嘔吐が2週毎に発生していた5歳女児症例について検討した。腹部超音波検査では肝円索付近に非血管病変が判明した。造影CTでは肝円索の右側にhyperdense lineとdisproportionate fat strandingに囲まれたlow attenuation massを認めた。腹水や出血はなく、肝円索膿瘍が示唆された。経口抗生物質投与で症状は改善し、待機的探索的腹腔鏡検査および切除術を計画した。マルチチャネルポートデバイスから臍に二つの5mmトロカール、右脇腹に一つの3mmトロカールを挿入した。腹腔の観察では肝円索に網が癒着しており、肉眼的観察では明らかな腫瘤病変は認めなかった。肝円索からの網癒着剥離術を行い、癒着形成部位を切除し、切除検体を臍創から摘出した。術後の経過は良好であった。病理学的所見では壊死性肝組織が判明し、切除組織は虚血性変化を伴った副肝葉であった。

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021229964

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021229963

Publisher：(株)東京医学社  

DOI： 10.24479/j00645.2021163596

Language：Japanese   Publisher：日本膵・胆管合流異常研究会  

DOI： 10.34410/jspbm.44.0_62

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：(株)東京医学社