Journal of the Japanese Society of Pediatric Surgeons

Purpose : The aim of our study is to evaluate the efficacy of continuos epidural infusion for postoperative pain relief in children. Method : A retrospective chart review was perfomed for all infants and children undergoing surgery between January 1998 and March 2000 at National Iwakuni Hospital. Epidural catheters were placed in 91 children, ranging in age from three months to 16 years. Epidural catheters utilized were either 18 or 19 gauge Tuohy needle with 20 or 23 gauge catheter-tube. Catheter placement was thoracic in 58 cases, lumbar in 11, and caudal in 22. Result : Epidural catheters were utilized for a duration of 3.5 to 5.0 days. Complications were nausea and vomiting (54% of patients), sensory blockade (4% of patients) and convulsion (1% of patients). In all patients, pain control was achieved with no serious neurological sequelae. Conclusion : Epidural anesthesia is a safe and efficient method to relieve pain in children postoperatively.

View full abstract

Show abstractHide abstract

Aim : The aim of this paper is to propose a newly designed method for estimation of the distance that the distal esophageal stump is stretched in patients with esophageal atresia with distal tracheoesophageal fistula (EA with TEF). Patients and methods : Thirty-three patients with EA with TEF were evaluated. When the TEF was cut off, the tracheal side was marked using a metallic clip. The distance between the clip and the anastomotic site was measured as the stretched length. On esophagrams taken afterwards, they were identified using the number of thoracic vertebra. Similarly, the distance and the post-operative length of the lower esophagus were also measured. Results : Sites of TEF and anastomosis were at the 3.9th and 3.3th thoracic vertebrae on the average, respectively. The stretched length during surgery was significantly correlated with that of the esophagram, and widely ranged from -14 mm to +21 mm. The average length of the lower esophagus was 62.5 mm. The stretching ratio was significantly correlated with and corresponded to the twofold value of the stretched length. Anastomotic leakage and recurrence of TEF were not experienced. In five patients with GER, the site of TEF was significantly lower than that in patients without, and the stretched length and the ratio were also longer and greater, respectively. Similar tendencies were observed for 4 patients with stricture. Conclusion : Estimation of the stretched length is beneficial to evaluate anastomotic tension. If the stretched length becomes over 10 mm, it is necessary to consider the possibility of stricture or GER, because this length corresponds to about 20% of that of the lower esophagus before anastomosis.

View full abstract

Download PDF (1053K)

Purpose : Currently, congenital cystic adenomatoid malformation of the lung (CCAM) is often diagnosed antenatally by ultrasonography. A new controversy has arisen as to whether the prognosis of such patients improves with antenatal treatment by thoracic drainage or surgical resection of the lesion. In order to discuss this point we retrospectively reviewed our experience with six cases of CCAM. Materials and Methods : From medical records we analyzed the clinical features of six cases of CCAM diagnosed antenatally from 1985 to 2000 at the hospital of Tokyo University. Results : Diagnosis of CCAM was made at an average of 25.8 weeks' gestation. Mean gestational age at birth was 36.1 weeks, and five patients underwent lobectomy surgery during the neonatal period. Using Stocker's classification, four patients were diagnosed as type I, one patient was type II, and one patient was type III. Three cases were complicated with hydrops. Among these cases, only one case with type I CCAM underwent fetal thoracocentesis and was successfully treated by postnatal lobectomy. Three patients without hydrops in fetal life remain alive. Conclusion : The prognosis of a fetus with CCAM and hydrops has been known empirically to be very poor. But it is now recommended that type I and type II CCAM with hydrops be treated antenatally by continuous drainage of the thoracic cavity. Type III CCAM patients with hydrops are still very hard to rescue, and the treatment strategy for such a fetus is still controversial, including the idea of surgical lobectomy in fetal life.

View full abstract

Purpose : Treatment of infantile umbilical hernia is still controversial. Authors compared outcomes between conservative observation and adhesive strapping for this disorder. Methods : Study was done prospectively from Jan. 1998 to Dec. 1999 at two institutes. Patients with umbilical hernia, less than 6 months old and more than 1, 500 g at birth, were observed only at A institute and were treated with adhesive strapping at B institute. Results : Twenty-four cases were followed at A. At 6 months of age, eleven cases (45.8%) them were cured and before one year of age seventeen cases (70.8%) healed spontaneously. 102 cases were treated with adhesiva strapping at B. All of the patients were healed completely at 6 months of age. There is a statistically significant (p<0.01) difference in healing rates between A and B institutes. Conclusion : Adhesive strapping is an effective procedure for early healing of infantile umbilical hernia.

View full abstract

Register with J-STAGE for free!