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 52, Issue 2
Displaying 1-15 of 15 articles from this issue
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Originals
  • Medium- to Long-Term Prognosis of Pediatric Patients With Gastrostomy
    Junko Mouri, Kenji Iio, Junji Kato, Norihiro Niimi, Shuichi Tanaka
    2016 Volume 52 Issue 2 Pages 233-238
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_233
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    Purpose: The number of pediatric gastrostomies has recently been increasing. However, caregivers often hesitate to consent to this operation because of its high risk. The age at gastrostomy insertion, complications, mortality, the rate of weaning from gastrostomy, the rate of continued utilization, the presence of antireflux surgery after gastrostomy, and the number of patients with tracheostomy or laryngotracheal separation were recorded among pediatric patients with gastrostomy.
    Methods: Gastrostomies were performed in 100 pediatric patients from January 2006 to February 2014. Gastroesophageal reflux disease was ruled out before gastrostomy for all patients by monitoring lower esophageal pH and by upper gastrointestinal series. For gastrostomy, either Stamm’s methods or laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEGs) was used.
    Results: Seven of the 100 pediatric patients were no longer followed up because of hospital transfers, 8 died of causes unrelated to gastrostomy, and only one was weaned from the gastrostomy device. Throughout the rest of the follow-up period, 84 underwent gastrostomy and 10 underwent antireflux surgery after gastrostomy. Only one patient received reconstruction of the gastrostomy due to leakage.
    Conclusions: Gastrostomy for pediatric patients is safe and appropriate, because weaning from gastrostomy is uncommon and the risk of gastrostomy is relatively low among pediatric patients.
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  • Surgical Procedure to Fix the Intestinal Tract to Regain Normal Function in Intestinal Malrotation
    Go Ohba, Hiroshi Yamamoto
    2016 Volume 52 Issue 2 Pages 239-242
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_239
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    Purpose: The usefulness of bowel fixation for intestinal malrotation is unclear. We carried out bowel fixation for intestinal malrotation after the Ladd procedure. We fixed the intestinal tract to be normal anatomically.
    Methods: The medical records of 17 patients with intestinal malrotation treated by this procedure between September 2006 and December 2014 were reviewed. We examined the operation time, complication and recurrence.
    Results: The operation time was 81 ± 22 min. There were no complications or recurrences.
    Conclusions: Our procedure may be considered as one of the options of fixation from the viewpoint of normal anatomical function.
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  • Favorable Effect of Rikkunshito on Gastroesophageal Reflux in Infants
    Tomoko Hatata, Shigeru Takamizawa, Katsumi Yoshizawa, Tamaki Iwade, Ka ...
    2016 Volume 52 Issue 2 Pages 243-246
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_243
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    Purpose: The cause of infantile gastroesophageal reflux (GER) in chronic respiratory disorders or pulmonary hypertension has been speculated. On the other hand, regurgitation and vomiting including GER in infants are often self-limiting, and may be assumed as a physiologic condition. Therefore, it is challenging to decide on surgical intervention for GER. The aim of this study is to evaluate a nonsurgical approach, i.e., the administration of Rikkunshito (RKT) for GER in infants.
    Methods: This is a retrospective analysis of 17 infants with GER treated with RKT. Twenty-five consecutive infants referred to us owing to vomiting were evaluated and 17 were diagnosed as having GER on the basis of upper gastrointestinal series and 24 h pH monitoring. The efficacy of RKT was evaluated on the basis of relief of clinical symptoms and improvement of pH.
    Results: RKT administration was continued in all 17 patients without any adverse effect. The initial dose of RKT was 0.27 g/kg/day on average, and the mean treatment period was 8 months. Unequivocal relief of clinical symptoms was obtained in 11 patients, and substantial improvement of pH was obtained in two of them. Antireflux surgery was not required in any of the patients.
    Conclusion: In the majority of infantile patients with GER, RKT alleviated the symptoms and rendered antireflux surgery unnecessary.
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  • Suture’s Loop Grasping Method in Laparoscopic Percutaneous Extraperitoneal Closure for Inguinal Hernia in Boys
    Yasuaki Taura, Masayuki Obatake, Takuya Yoshida, Yusuke Yamane, Taiich ...
    2016 Volume 52 Issue 2 Pages 247-251
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_247
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    Purpose: We investigated the benefit of the suture’s loop grasping method to reduce the risk of injury to the ductus deferens, artery and vein for inguinal hernia in boys when we used Lapa-Her-ClosureTM several times during laparoscopic percutaneous extraperitoneal closure (LPEC).
    Methods: We can perform double ligations in a single procedure for inguinal hernia by holding a suture’s loop with Lapa-Her-ClosureTM. Thirteen boys with inguinal hernia underwent LPEC by this method from March to October 2015.
    Results: The median operative duration of LPEC by this method was 31.5 min, and this was almost the same as that of the conventional LPEC. We experienced the cutting of a suture once, but were able to ligate it with another suture. It was free of surgical complications such as wound infection or recurrence associated with this method.
    Conclusions: This method is very useful because it reduces the risk of organ injury and avoids the extension of the operative duration of LPEC.
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  • Current Status of the Diagnosis and Treatment of Congenital Anomalies of the Esophagus: An Analysis of a Survey Conducted during the 45th Annual Meeting of Kyushu Pediatric Surgeons
    Masaya Suzuhigashi, Hiroyuki Noguchi, Kazuhiko Nakame, Motoi Mukai, Ta ...
    2016 Volume 52 Issue 2 Pages 252-258
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_252
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    Purpose: The aim of this study was to evaluate recent trends in the epidemiology, diagnosis and treatment of congenital anomalies of the esophagus.
    Methods: A questionnaire survey regarding esophageal atresia (EA) and congenital esophageal stenosis (CES) treated over the last 10 years was carried out at pediatric surgical centers in the Kyushu, Okinawa, and Yamaguchi areas.
    Results: Twenty out of 29 institutions (69%) answered our questionnaires. One hundred and ninety patients with EA and 39 patients with CES were thus recruited in this study. Five centers treated no patients with EA, one center treated 1–5 patients, 7 centers 6–10 patients, 5 centers 15–20 patients, and 2 centers 20–25 patients. Forty-seven out of 174 (27%) patients were diagnosed prenatally. Regarding the surgical approach, posterolateral incisions were performed in 60% of the centers. The overall survival rate was 73.7% in all patients. The survival rate in patients who underwent operation was 90.9%. Sixty-three percent of the infants weighed less than 2,500 g, and 14.7% weighed less than 1,500 g. Among the 39 patients with CES, the causes of CES were as follows: tracheobronchial remnants in 12 patients, fibromuscular stenosis in 10 patients, and membranous stenosis in 3 patients. The incidence of associated anomalies was 35.9%, and that associated with esophageal atresia was 15.4%. The onset of symptoms occurred in late infancy in 56.8% and in the neonatal period in 21.6%.
    Conclusions: EA patients with primary anastomosis demonstrated a favorable prognosis. CES patients also developed symptoms and all such patients were diagnosed in the neonatal period.
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  • Surgical Timing Determines Circumferential Contraction Rate in Giant Umbilical Hernia
    Isamu Saeki, Reiko Kato, Wataru Mukai, Reisuke Imaji, Takashi Akiyama
    2016 Volume 52 Issue 2 Pages 259-263
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_259
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    Purpose: We previously reported the cases of four patients presenting with giant umbilical hernia (≧20 mm diameter) operated in early infancy. All the patients had good cosmetic outcome of the umbilicus with a markedly smaller circumference.Methods: This time, we compared the circumference of the umbilicus after giant umbilical hernia surgery between 10 patients of the early surgical timing group (1–4 months old) and 8 patients of the normal surgical timing group (1–2 years old).Results: In the early surgical timing group, the mean diameter of the umbilicus markedly decreased from 26.7 to 13.3 mm, whereas in normal surgical timing group, the mean diameter decreased from 26 to 21.5 mm (P < 0.01).Conclusions: Early surgical closure of umbilical hernia is easy and results in a reduced circumference of the umbilicus and good cosmetic outcome compared with the normal timing of surgery.
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Case Reports
  • Idiopathic Posttransplantation Hepatitis in a Pediatric Liver Transplant Recipient: A Case Report
    Yukari Sakae, Yoshiki Morotomi, Shoji Kubo, Shigekazu Takemura, Miwa S ...
    2016 Volume 52 Issue 2 Pages 264-269
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_264
    JOURNAL FREE ACCESS
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    De novo autoimmune hepatitis (AIH) can occur in patients who underwent living donor liver transplantation (LDLT). We encountered a male patient, who, at age 2 years, underwent LDLT owing to a failed Kasai operation. Seven years later, at age 10 years, serum, AST, ALT and globulin levels were markedly elevated, but he was negative for autoantibodies. Liver biopsy showed interface hepatitis. He was diagnosed as having idiopathic posttransplantation hepatitis and was treated with steroids. Although his liver enzyme and globulin levels rapidly returned to normal, a repeat liver biopsy continued to show interface hepatitis.
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  • A Case of Infantile Undifferentiated Embryonal Sarcoma of the Liver
    Megumi Kobayashi, Masaru Mizuno
    2016 Volume 52 Issue 2 Pages 270-274
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_270
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    We report a case of infantile undifferentiated embryonal sarcoma of the liver, which favorably progressed following treatment by complete tumorectomy and postoperative adjuvant chemotherapy. The patient was a 3-year-old boy who was brought to our hospital for chief complaints of fever and vomiting. A mass as large as a child’s head was palpated in the right upper quadrant of the abdomen. His α-fetoprotein level was within the normal range. Following hospital admission, the mass increased in size. Therefore, a partial hepatectomy was performed as part of a complete tumorectomy. Upon the diagnosis of undifferentiated embryonal sarcoma of the liver based on histopathological findings, postoperative adjuvant chemotherapy was administered with vincristine/doxorubicin/cyclophosphamide and ifosfamide/etoposide therapies. Postoperative computed tomography, magnetic resonance imaging, or positron emission tomography-computed tomography revealed no abnormal findings, and there was no increase in the levels of specific tumor markers. In recent years, undifferentiated embryonal sarcoma of the liver has been described in many reports. Its treatment and prognosis are significantly improved. However, there are no specific tumor markers or image findings and no established evaluation or treatment methods for this condition. Our patient presented with no specific findings and is continuing to receive treatment; thus, we struggle to evaluate recurrence and metastasis.
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  • A Case of Subcutaneous Bronchogenic Cyst in an Infant
    Kouichi Sakamoto, Masayuki Obatake, Kazuhiro Hanasaki
    2016 Volume 52 Issue 2 Pages 275-280
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_275
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    We report a case of suprasternal subcutaneous bronchogenic cyst (SBC) in a 1-year-old boy. A suprasternal mass was noticed in the boy since he was a neonate. Infection occurred at the age of 1 year and 8 months, and drainage was performed. After the remission of infection, cyst resection was performed. The cyst was excised at the upper episternum. There was neither adhesion to bone nor fistula. On the basis of histopathologic analysis, we diagnosed it as SBC. Bronchogenic cyst (BC) usually occurs at the mediastinum, and SBC is rare. For the treatment of SBC, early resection is recommended, taking into account the high risk of infection.
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  • Case Report: Torsion of Meckel’s Diverticulum With Small Bowel Obstruction
    Kaori Okamura, Kyosuke Tatsuta, Noritoshi Handa
    2016 Volume 52 Issue 2 Pages 281-285
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_281
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    We report on a rare case of torsion of Meckel’s diverticulum at the neck associated with an internal hernia caused by a mesodiverticular band. A 5-year-old boy was admitted to our hospital because of severe abdominal pain and vomiting. Abdominal CT demonstrated a dilatation of the small intestine and a blind-ending luminal structure in the pelvic cavity. We diagnosed the boy as having an intestinal obstruction due to Meckel’s diverticulum and performed emergency laparotomy. Intraoperatively, the ileal loop was strangulated by a foramen caused by a mesodiverticular band, which extended from the top of the diverticulum to the retroperitoneum, and the twisted Meckel’s diverticulum at its neck was encountered. After the entrapped ileum was reduced, Meckel’s diverticulum was resected. His postoperative course was uneventful.
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  • A Case of Prepubertal Unilateral Fibrous Hyperplasia of the Labium Majus
    Kiyoaki Yabe, Aki Matsuoka, Ayako Takenouchi, Katsunori Kouchi
    2016 Volume 52 Issue 2 Pages 286-290
    Published: April 20, 2016
    Released on J-STAGE: April 20, 2016
    DOIhttps://doi.org/10.11164/jjsps.52.2_286
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    Prepubertal unilateral fibrous hyperplasia (PUFH) of the labium majus is characterized by unilateral soft tissue enlargement of the labium majus in prepubertal girls. An 8-year-old girl presented with a painless swelling of the left labium majus. The left labium majus showed a soft and ill-defined enlargement. T1- and T2-weighted MR images revealed a hypointense and ill-defined mass in the left labium majus. Enhanced contrast CT showed a hypovascular mass. These imaging examinations suggested the growth of fibrous tissue in the labium majus. The lesion enlarged gradually. We extirpated the mass. Histopathologic findings revealed PUFH. The patient has been followed up for two years without recurrence. PUFH is a new disease and the literature on this condition is scant, but we take into consideration PUFH as a differential diagnosis of the unilateral swelling of the labium majus in prepubertal girls.
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