Journal of the Japanese Society of Pediatric Surgeons
Online ISSN : 2187-4247
Print ISSN : 0288-609X
ISSN-L : 0288-609X
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Volume 49, Issue 6
Displaying 1-19 of 19 articles from this issue
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  • To Investigate the Efficacy of Wound Irrigation for Wound Infection Prophylaxis and the Effects of Dermal Suturing on Wound Infection
    Chiyoe Shirota
    2013 Volume 49 Issue 6 Pages 1082-1086
    Published: October 20, 2013
    Released on J-STAGE: October 20, 2013
    DOIhttps://doi.org/10.11164/jjsps.49.6_1082
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    Purpose: To investigate the efficacy of wound irrigation for surgical site infection (wound infection) prophylaxis and the effects of dermal suturing on wound infection.
    Methods: In patients aged ≤15 years who underwent surgery for perforated appendicitis, a comparison was conducted between patients for whom wound irrigation was performed (treated between 2005 and 2011; irrigation group, n = 52) and patients for whom wound irrigation was not performed (treated between 2002 and 2004; non-irrigation group, n = 13). Full-thickness suturing was performed in all patients until September 2006, where dermal suturing was initiated due to sustained absence of wound surgical site infection following the implementation of wound irrigation.
    Results: Significantly fewer cases of wound infection were observed in the irrigation group (n = 2, 3.8%) than in the non-irrigation group (n = 4, 31%). In the irrigation group, full-thickness and dermal suturing were performed in 15 and 37 patients, respectively. No significant difference in wound infection rates was observed by the suture type, with 1 patient of each suture type developing wound infection in the irrigation group.
    Conclusion: Wound irrigation may be effective for wound infection prophylaxis in patients with surgery for appendicitis. Furthermore, dermal suturing does not increase the risk of surgical site infection.
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  • Significance of Tumor Biopsy in Children With Malignant Tumors
    Masaki Horiike, Koichi Ohno, Tetsuro Nakamura, Takashi Azuma, Tatsuo N ...
    2013 Volume 49 Issue 6 Pages 1087-1090
    Published: October 20, 2013
    Released on J-STAGE: October 20, 2013
    DOIhttps://doi.org/10.11164/jjsps.49.6_1087
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    Purpose: In multidisciplinary therapy for pediatric cancer, accurate pathological diagnosis is essential, and the most suitably designed chemotherapy regimen must be initiated as soon as possible after biopsy. We retrospectively evaluated our methods for tumor biopsy.
    Methods: We reviewed the clinical records of 61 patients of 4.9 ± 5.0 years old (mean ± SD) with the following malignant tumors: Neuroblastoma (n = 25), malignant lymphoma (n = 12), nephroblastoma (n = 5), rhabdomyosarcoma (n = 5), hepatoblastoma (n = 1), and others (n = 13).
    Results: The mean operative time was 124 ± 41 min. Blood loss was 36 ± 50 g; tumors were approached by laparotomy in 42, thoracotomy in 2, subcutaneous lymphnode biopsy in 11, and other procedures in 6 patients. Specimens were obtained from the main tumors in 52, and from metastatic lesions in 9 patients. We did not observed surgical complications in any patient, and pathological diagnosis of the biopsy specimen coincided well with that of the resected tumor. The mean time period between the tumor biopsy and the commencement of chemotherapy was 5.6 ± 4.4 days.
    Conclusions: We obtained adequate specimens with our biopsy technique, and the respective specimens provided accurate pathological diagnoses. Because the respective specimens from the metastatic lesions also facilitated pathological diagnoses, it suggests that biopsy specimens from metastatic lesions could be useful in certain fragile patients.
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  • Technical Devisal of Laryngotracheal Separation for Intractable Aspiration
    Takashi Sasaki, Hiroomi Okuyama, Satoko Nose, Ryuta Saka
    2013 Volume 49 Issue 6 Pages 1091-1095
    Published: October 20, 2013
    Released on J-STAGE: October 20, 2013
    DOIhttps://doi.org/10.11164/jjsps.49.6_1091
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    Purpose: In laryngotracheal separation (LTS) for intractable aspiration, we devised a novel technical innovation to the conventional Lindeman's operation. We herein introduce and report the results of this novel method.
    Methods: The upper tracheal end was firmly closed in a conventional fashion. The lower end was kept in situ by minimizing the dissection as long as the seam to the skin was secured. Sufficient skin flap was made by dissecting the cranial skin at the subcutaneous level, and was then stitched closed with the lower tracheal end covering the closed upper tracheal end. A total of 12 patients underwent this procedure consecutively during the last four years. Intra- and post-operative results were retrospectively examined.
    Results: The median age at operation was four years and seven months. They consisted of five boys and seven girls. Nine of them have already undergone tracheostomy. The average operative time was 99 +/– 31 minutes with limited blood loss. None had any intraoperative complication or anastomotic failure. During the average observation period of 26 months, there were no late complications such as anastomotic stricture and tracheoinnominate artery fistula.
    Conclusion: These results indicate that our method was safe and less-invasive, and may serve as an alternative to the conventional LTS.
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  • Efficacy of Postoperative Artificial Ventilation Under Deep Sedation or Paralysis in Gross C Esophageal Atresia
    Yasuo Nakahara, Yoshinobu Iwamura, Akira Nii, Masahiro Kawasaki, Takas ...
    2013 Volume 49 Issue 6 Pages 1096-1100
    Published: October 20, 2013
    Released on J-STAGE: October 20, 2013
    DOIhttps://doi.org/10.11164/jjsps.49.6_1096
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    Purpose: There has been little evidence to support postoperative ventilation under deep sedation or muscle paralysis in standard Gross C esophageal atresia improves its outcome. So we evaluated its efficacy with the data from four institutions in Chugoku and Shikoku area.
    Methods: Among patients with esophageal atresia who underwent radical operation in four institutions between April 2005 and December 2011, patients with standard Gross C esophageal atresia were selected (patients associated with complex cardiac anomaly of less than 1,500 g, long-gap atresia were excluded). Based on the postoperative management, the patients were divided into two groups: Group I (Sedation –) and Group II (Sedation +). The postoperative course and complications were compared in these groups.
    Results: A total of 21 patients were enrolled (Group I, n = 10 and Group II, n = 11). The median postoperative intubation periods and extrapleural drainage periods were significantly longer in Group II. The median periods until the first oral intake and the postoperative hospital stay were not significantly different between these groups. There were no significant differences in anastomotic leak and stricture rate between these groups. A patient in Group II experienced recurrent fistula and bedsore. The postoperative atelectasis was significantly higher in Group II.
    Conclusions: It was not confirmed that postoperative ventilation under deep sedation or muscle paralysis provided any positive effect after repair of Gross C esophageal atresia.
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  • Usefulness of the Percutaneous Endoscopic Gastrostomy Procedure With the Seldinger Technique Combined With a Percutaneous Anchoring Device for Children
    Yasuyuki Mitani, Katsunari Takifuji, Takashi Watanabe, Akio Kubota, Hi ...
    2013 Volume 49 Issue 6 Pages 1101-1105
    Published: October 20, 2013
    Released on J-STAGE: October 20, 2013
    DOIhttps://doi.org/10.11164/jjsps.49.6_1101
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    Purpose: Recently, gastrostomy has become a more important procedure because severe neonatal patients requring enteral nutrition have been rescued. The method of gastrostomy for children needs to be simple and safe. We report the usefulness of the percutaneous endoscopic gastrostomy (PEG) procedure with the seldinger technique combined with a percutaneous anchoring device (S-PEG) for children.
    Methods: Fifteen pediatric patients below 16 years old, who underwent PEG from January 2007 to December 2012 in our institute, were retrospectively reviewed.
    Results: The mean operative time was 26.9 ± 3.7 minutes. There were no operative complications. One case was converted to laparoscopic operation. Postoperative complications were found in 2 cases with infection of the anchoring suture, and 4 cases with granulation around gastrostomy tube, which were subsequently treated by conservative therapies. There was no complication of gastrostomy tube exchange.
    Conclusions: PEG with the Seldinger technique combined with a percutaneous anchoring device (S-PEG) is simple, safe, and is a very useful technique for children.
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Case Reports
  • A Case of Omental Cyst Containing CSF Associated With a VP Shunt
    Kyosuke Tatsuta, Ryuichiro Hirose, Naohiro Kawakubo, Satoshi Toyoshima ...
    2013 Volume 49 Issue 6 Pages 1106-1111
    Published: October 20, 2013
    Released on J-STAGE: October 20, 2013
    DOIhttps://doi.org/10.11164/jjsps.49.6_1106
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    This report presents a seven-month-old boy with a large abdominal omental cyst containing cerebrospinal fluid (CSF) after VP shunt placement. The VP shunt was placed due to hydrocephalus after intraventricular hemorrhage at age three months. Since six months old, he has been having symptoms of abdominal distension, vomiting, and poor feeding. Abdominal US and contrast-enhanced CT showed a large abdominal cyst enclosing the VP shunt catheter. Through a minimal lower umbilical incision, laparoscopy revealed that the cyst consisted of an omentum filled with CSF. Thereafter, the cyst was extirpated extracorporeally, and the shunt catheter was returned to the peritoneal space. However the omental cyst containing CSF is a very rare condition, and has been reported only in 4 cases in the world to date., It should be noted that differential diagnosis is warranted for abdominal cysts associated with a VP shunt.
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  • Absence of α Smooth Muscle Actin Immunoreactivity in the Ileum Muscularis Propria Circular Layer of Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) Associated With Impaired Light Reflex
    Hajime Takayasu, Kiyoshi Tanaka, Eiichiro Watanabe, Masahiko Watanabe
    2013 Volume 49 Issue 6 Pages 1112-1116
    Published: October 20, 2013
    Released on J-STAGE: October 20, 2013
    DOIhttps://doi.org/10.11164/jjsps.49.6_1112
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    A male baby was referred antenatally at 22 weeks of gestation because of a megabladder. Obstructive urethral disease was suspected and ultrasound-guided bladder puncture and/or placement of a vesico-amniotic shunt was repeated. Contrast enema revealed a microcolon while an upper gastrointestinal series demonstrated an atonic distended stomach with little passage of contrast media from the stomach to the duodenum. A rectal suction biopsy demonstrated normal acetylcholinesterase activity and intact ganglion cells. Accordingly, the patient was diagnosed as having megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS). At 42 days of age the infant underwent emergent laparotomy because of abdominal distension with massive intestinal bleeding. We performed jejunostomy for tube-feeding and ileostomy for drainage of intestinal contents. Despite feeding attempts with aggressive prokinetic regimens, the infant continued to show enteral feeding intolerance, and subsequently died of liver failure with massive intestinal bleeding at 7 months of age. Opthalmologic evaluations revealed that the pupils responded poorly to light stimuli. Immunohistochemical staining for alpha smooth muscle actin indicated that it was selectively absent in the circular layer of muscularis propria in the ileum, although the optical microscopic appearance was normal. Based on the ophthalmologic and immunohistochemical findings of the intestine, the present case of MMIHS may be an intestinal myopathy related to acetylcholine receptor abnormality.
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  • A Case of Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) Successfully Cared for by Surgery
    Hirofumi Shimizu, Kazuya Ise, Michitoshi Yamashita, Show Ishii, Kei Na ...
    2013 Volume 49 Issue 6 Pages 1117-1121
    Published: October 20, 2013
    Released on J-STAGE: October 20, 2013
    DOIhttps://doi.org/10.11164/jjsps.49.6_1117
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    Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is one of the most severe diseases involving functional intestinal obstruction in the newborn. We report a case of MMIHS successfully cared for by surgery. The patient was a 22-month-old girl. After birth, she developed bilious vomiting and was diagnosed with MMIHS based on radiographic contrast studies. She underwent jejunostomy and gastrostomy at the neonatal period, transverse colostomy at 6 months old, appendicostomy at one year old, and partial colectomy with dilatation at 15 months old. To avoid enteritis, we continued to undertake intestinal lavage with help from her parents. She was fed on both enteral alimentation and parenteral nutrition. It was important that surgical treatments for the patients with MMIHS were appropriated according to the disease condition. Prevention of enteritis by appropriate surgery could have contributed to improving the QOL and prognosis.
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  • A Low-Birth-Weight Newborn Undergoing Slide Tracheoplasty for Congenital Tracheal Stenosis
    Keiichi Morita, Koji Fukumoto, Maki Mitsunaga, Masaya Yamoto, Hiroshi ...
    2013 Volume 49 Issue 6 Pages 1122-1126
    Published: October 20, 2013
    Released on J-STAGE: October 20, 2013
    DOIhttps://doi.org/10.11164/jjsps.49.6_1122
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    We report a low-birth-weight newborn who underwent slide tracheoplasty for congenital tracheal stenosis (CTS), and subsequently led to removal of the tube. A female infant born at 35 weeks and 1 day of gestation with a weight of 1,777 g presented dyspnea immediately after birth, and received tracheal intubation. However, the tracheal tube with an inner diameter of 2.5 mm (an outer diameter of 3.5 mm) could not be placed beyond the glottis. Chest computed tomography examination revealed stenosis localized in the upper part of trachea, and CTS was suggested. Since her respiration could not be maintained in a stable condition, she underwent operation at the age of 4 days. CTS occupied 28.6% of the entire length of the trachea was found in the upper part of trachea, and cervical slide tracheoplasty without cardiopulmonary bypass was performed. The tube was removed 15 days after operation. At present, 3 months after the operation, her respiratory condition continues to remain stable. Slide tracheoplasty is useful for CTS involving localized and absolutely narrow stenosis.
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  • A Case of Congenital Laryngeal Atresia Accompanied by Type-D Esophageal Atresia
    Yasuaki Taura, Masayuki Obatake, Yukio Inamura, Taichiro Kosaka, Takes ...
    2013 Volume 49 Issue 6 Pages 1127-1130
    Published: October 20, 2013
    Released on J-STAGE: October 20, 2013
    DOIhttps://doi.org/10.11164/jjsps.49.6_1127
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    We report a male neonatal case of congenital laryngeal atresia with type-D esophageal atresia. He was suspected of esophageal atresia because of hydramnion. He was delivered with a birth weight of 2,080 g, and his Apgar score was 1 at both postpartum 1 and 5 minutes. He was not crying and had severe cyanosis after birth. Endotracheal intubation was unsuccessful, although he could breathe stably with esophageal intubation. He was diagnosed with congenital laryngeal atresia with type-D esophageal atresia from findings of his X-ray, neck and chest computed tomography, and bronchoscopy. We performed tracheostomy when he was one day old. More than half of congenital laryngeal atresia cases reported in Japan have complications such as esophageal atresia and/or congenital cardiac anomaly, and we should examine the various etiological aspects and symptoms relevant to congenital laryngeal atresia to provide an appropriate medical treatment.
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