Publications by authors named "Keisuke Yano"

43 Publications

A safe and effective laparoscopic Ladd's procedure technique involving the confirmation of mesenteric vascular perfusion by fluorescence imaging using indocyanine green: A case report of an infant.

Asian J Endosc Surg 2022 Jan 5. Epub 2022 Jan 5.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

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.
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http://dx.doi.org/10.1111/ases.13026DOI Listing
January 2022

Ambidextrous needle driving and knot tying helps perform secure laparoscopic hepaticojejunostomy of choledochal cyst (with video).

J Hepatobiliary Pancreat Sci 2021 Dec 13. Epub 2021 Dec 13.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

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http://dx.doi.org/10.1002/jhbp.1100DOI Listing
December 2021

The protective effects of hepatocyte growth factor on the intestinal mucosal atrophy induced by total parenteral nutrition in a rat model.

Pediatr Surg Int 2021 Dec 26;37(12):1743-1753. Epub 2021 Aug 26.

Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.

Purpose: Total parental nutrition (TPN) causes gastrointestinal mucosal atrophy. The present study investigated the effects of hepatocyte growth factor (HGF) on the intestinal mucosal atrophy induced by TPN.

Methods: Rats underwent jugular vein catheterization and were divided into four groups: oral feeding (OF), TPN alone (TPN), TPN plus low-dose HGF (0.3 mg/kg/day; TPNLH), and TPN plus high-dose HGF (1.0 mg/kg/day; TPNHH). On day 7, rats were euthanized, and the small intestine was harvested and evaluated histologically. The expression of c-MET, a receptor of HGF, and nutrition transporter protein were evaluated using quantitative polymerase chain reaction.

Results: The jejunal villus height (VH) and absorptive mucosal surface area in the TPNHH group were significantly higher than in the TPN group (p < 0.05). The VH in the ileum showed the same trend only in the TPNHH group, albeit without statistical significance. The crypt cell proliferation rate (CCPR) of the jejunum in both HGF-treated groups was significantly higher than in the TPN group (p < 0.01). The expression of c-MET and transporter protein in all TPN-treated groups was decreased compared with that in the OF group.

Conclusion: HGF attenuated TPN-associated intestinal mucosal atrophy by increasing the villus height, which was associated with an increase in CCPR.
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http://dx.doi.org/10.1007/s00383-021-05002-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8563669PMC
December 2021

Optimal timing of definitive surgery for Hirschsprung's disease to achieve better long-term bowel function.

Surg Today 2022 Jan 12;52(1):92-97. Epub 2021 Aug 12.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.

Purpose: Few studies have focused on the operative age for Hirschsprung's disease (HD). We evaluated the optimal timing of surgery in HD patients based on their long-term bowel function.

Methods: HD was diagnosed in 65 pediatric patients in our institute between 1992 and 2018. Twenty-five patients underwent the Soave-Denda procedure (SD) and 40 underwent transanal endorectal pull-through (TA). We divided these patients into two groups: those who underwent surgery at < 6 months of age (younger group) and those who underwent surgery at 6-12 months of age (older group). We assessed bowel function at 5, 7, and 9 years of age.

Results: The bowel function of the patients who underwent the SD did not differ significantly between the groups. Similarly, the total bowel-function scores of the patients who underwent TA did not differ between the groups at any age. However, the soiling score at 7 years of age in the older group of patients who underwent TA was significantly lower than that in the younger group (p = 0.02).

Conclusions: Our data suggest that to achieve optimal bowel function, TA should be performed at < 6 months of age.
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http://dx.doi.org/10.1007/s00595-021-02356-9DOI Listing
January 2022

Retroperitoneal teratomas in children: a single institution experience.

Surg Today 2022 Jan 19;52(1):144-150. Epub 2021 Jun 19.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.

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.
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http://dx.doi.org/10.1007/s00595-021-02327-0DOI Listing
January 2022

A rare case of accessory liver lobe torsion in a pediatric patient who showed recurrent epigastralgia and who was treated by elective laparoscopic resection.

Surg Case Rep 2021 Jun 15;7(1):143. Epub 2021 Jun 15.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.

Background: Accessory liver lobe (ALL) is a rare liver malformation. An ALL develops due to malformation of the endodermal caudal foregut and segmentation of the hepatic bud in the third week of gestation. Most ALLs are asymptomatic and are detected incidentally during abdominal surgery. The incidence of ALL is < 1% in patients who undergo abdominal surgery. However, some ALLs twist and cause acute abdomen. We experienced a pediatric case of ALL torsion in a patient who underwent elective laparoscopic surgery.

Case Presentation: The 5-year-old girl had a 3-month history of epigastralgia and vomiting, which occurred every 2 weeks. Abdominal ultrasonography with color Doppler imaging revealed an 11.8 × 13.6 mm nonvascular lesion with mixed echogenicity near the round ligament of the liver. Enhanced computed tomography confirmed a 14 × 16 × 20 mm low-attenuation mass surrounded by a hyperdense line and disproportionate fat stranding on the right side of the round ligament of the liver. There was no ascites or hemorrhage. These findings suggested an abscess of the round ligament of the liver. Her symptoms improved with the administration of oral antibiotics; thus, we planned to perform elective exploratory laparoscopy and subsequent resection. Two trocars (5 mm) were inserted through a multichannel port device at the umbilicus and one trocar (3 mm) was inserted at the right lateral abdomen. Upon observation of the abdominal cavity, the omentum was observed adhering to the round ligament of the liver. Macroscopic observation revealed no apparent mass lesions. We performed adhesiolysis of the omentum from the round ligament of the liver using a vessel sealing system. We performed resection at the site at which adhesion had formed between the round ligament of the liver with the surrounding tissue using a vessel sealing system and the resected specimen was extracted through the umbilical wound. The postoperative course was uneventful. A pathological examination revealed necrotic liver tissue. The resected tissue was founded to be an ALL with ischemic change.

Conclusions: The recurrent abdominal pain was induced by torsion of the ALL. Pediatric surgeons should consider ALL torsion as a differential diagnosis for epigastralgia of unknown etiology.
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http://dx.doi.org/10.1186/s40792-021-01231-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206295PMC
June 2021

A retrospective analysis of the real-time ultrasound-guided supraclavicular approach for the insertion of a tunneled central venous catheter in pediatric patients.

J Vasc Access 2021 Apr 7:11297298211008084. Epub 2021 Apr 7.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

Purpose: Tunneled central venous catheter (tCVC) placement plays an important role in the management of pediatric patients. We adopted a real-time ultrasound (US)-guided supraclavicular approach to brachiocephalic vein cannulation. We evaluated the outcomes of tCVC placement via a US-guided supraclavicular approach.

Methods: A retrospective study was performed for patients who underwent US-guided central venous catheterization of the internal jugular vein (IJV group) and brachiocephalic vein (BCV group) in our institution. The background information and outcomes were reviewed using medical records.

Results: We evaluated 85 tCVC placements (IJV group:  = 59, BCV group:  = 26). Postoperative complications were recognized in 19 patients in the IJV group (catheter-related bloodstream infection (CRBSI),  = 14 (1.53 per 1000 catheter days); occlusion,  = 1 (1.7%, 1.09 per 1000 catheter days); accidental removal,  = 3 (5.2%, 0.33 per 1000 catheter days); and other,  = 1 (1.7%, 1.09 per 1000 catheter days)) and five patients in the BCV group (CRBSI,  = 2 (0.33 per 1000 catheter days); catheter damage,  = 1 (3.8%, 1.67 per 1000 catheter days); and accidental removal,  = 2 (7.7%, 0.33 per 1000 catheter days)). In the BCV group, despite that, the incidence of postoperative complications was lower ( = 0.205) and the period of placement was significantly longer in comparison to the IJV group ( = 0.024).

Conclusion: US-guided placement of tunneled CVC though the BCV results in a low rate of postoperative complications despite longer CVC indwelling times compared to IJV insertion. Our results suggest that BCV insertion of tunneled CVC in children may offer advantages in terms of device performance and patient safety.
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http://dx.doi.org/10.1177/11297298211008084DOI Listing
April 2021

Differential gastric emptiness according to preoperative stomach position in neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy.

Surg Today 2021 Dec 30;51(12):1918-1923. Epub 2021 Mar 30.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.

Purpose: We sometimes experienced prolonged delayed gastric emptying (DGE) in neurologically impaired patients undergoing laparoscopic fundoplication and gastrostomy. We explored the difference in the DGE rate according to the preoperative stomach position.

Methods: Thirty-two neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy between 2015 and 2019 were classified into two groups based on stomach position: non-elevated stomach position (NESP) and elevated stomach position (ESP). Patients' characteristics, operative result and postoperative gastric emptying were reviewed.

Results: The 11 ESP patients were significantly older than the 21 NESP patients (p < 0.05). The ESP patients had a significantly heavier body weight (BW) than the NESP patients (p < 0.05). The time taken (days) to reduce gastric drainage (days, below BW × 10 ml) in the NESP (4.3 ± 3.6) was significantly longer than that of ESP (1.3 ± 1.6) (p < 0.05). The time taken (days) to achieve full enteral nutrition in the NESP (14.1 ± 8.9) was significantly longer than that of the ESP patients (8.8 ± 3.1) (p < 0.05).

Conclusion: Elevated stomach position (ESP) patients archived full enteral nutrition earlier than NESP patients after laparoscopic fundoplication and gastrostomy. Stomach position correction might, therefore, be involved in the incidence of DGE.
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http://dx.doi.org/10.1007/s00595-021-02274-wDOI Listing
December 2021

The evaluation of eye gaze using an eye tracking system in simulation training of real-time ultrasound-guided venipuncture.

J Vasc Access 2021 Feb 12:1129729820987362. Epub 2021 Feb 12.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

Purpose: Real-time ultrasound (RTUS)-guided central venipuncture using the short-axis approach is complicated and likely to result in losing sight of the needle tip. Therefore, we focused on the eye gaze in our evaluation of the differences in eye gaze between medical students and experienced participants using an eye tracking system.

Methods: Ten medical students (MS group), five residents (R group) and six pediatric surgeon fellows (F group) performed short-axis RTUS-guided venipuncture simulation using a modified vessel training system. The eye gaze was captured by the tracking system (Tobii Eye Tacker 4C) and recorded. The evaluation endpoints were the task completion time, total time and number of occurrences of the eye tracking marker outside US monitor and success rate of venipuncture.

Result: There were no significant differences in the task completion time and total time of the tracking marker outside the US monitor. The number of occurrences of the eye tracking marker outside US monitor in the MS group was significantly higher than in the F group (MS group: 9.5 ± 3.4, R group: 6.0 ± 2.9, F group: 5.2 ± 1.6;   0.04). The success rate of venipuncture in the R group tended to be better than in the F group.

Conclusion: More experienced operators let their eye fall outside the US monitor fewer times than less experienced ones. The eye gaze was associated with the success rate of RTUS-guided venipuncture. Repeated training while considering the eye gaze seems to be pivotal for mastering RTUS-guided venipuncture.
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http://dx.doi.org/10.1177/1129729820987362DOI Listing
February 2021

Early definitive operation for patients with anorectal malformation was associated with a better long-term postoperative bowel function.

Pediatr Surg Int 2021 Apr 25;37(4):445-450. Epub 2021 Jan 25.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.

Purpose: In general, patients with anorectal malformation (ARM) undergo surgical treatment at around 6 months of age in Japan. We aimed to clarify whether the timing of a definitive operation affects the long-term bowel function.

Methods: Patient data were collected from 1984 to 2007. Fifty-two male patients with high- and intermediate-type ARM were enrolled. Patients were classified into two groups based on their operative period: the early group (EG) underwent anorectoplasty at < 5 months of age (n = 22); the late group (LG) underwent anorectoplasty at ≥ 5 months (n = 30). The bowel function was evaluated at 3, 5, 7, 9, and 11 years of age using the evacuation score (ES) of the Japan Society of Anorectal Malformation Study Group.

Results: The total score and four functional outcomes improved chronologically with age. The constipation score in the EG showed significantly better improvement in comparison to the LG. The total score and the incontinence score in the EG were significantly higher than those in the LG at 11 years of age.

Conclusion: The long-term bowel function in the EG was better than that in the LG. Anorectoplasty at an early age was important for achieving a better postoperative bowel function in ARM patients.
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http://dx.doi.org/10.1007/s00383-020-04842-6DOI Listing
April 2021

An overview of the current management of short-bowel syndrome in pediatric patients.

Surg Today 2022 Jan 19;52(1):12-21. Epub 2021 Jan 19.

Department of Pediatric Surgery, Research Field Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

Short-bowel syndrome (SBS) is defined as a state of malabsorption after resection or loss of a major portion of the bowel due to congenital or acquired factors. This article presents an overview on the recent management of pediatric SBS. The pediatric SBS population is very heterogeneous. The incidence of SBS is estimated to be 24.5 per 100,000 live births. The nutritional, medical, and surgical therapies available require a comprehensive evaluation. Thus, multidisciplinary intestinal rehabilitation programs (IRPs) are necessary for the management of these complex patients. The key points of focus in IRP management are hepato-protective strategies to minimize intestinal failure-associated liver disease; the aggressive prevention of catheter-related bloodstream infections; strategic nutritional supply to optimize the absorption of enteral calories; and the management and prevention of small bowel bacterial overgrowth, nephrocalcinosis, and metabolic bone disease. As the survival rate of children with SBS currently exceeds 90%, the application of small bowel transplantation has been evolving. The introduction of innovative treatments, such as combined therapy of intestinotrophic hormones, including glucagon-like peptide-2, may lead to further improvements in patients' quality of life.
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http://dx.doi.org/10.1007/s00595-020-02207-zDOI Listing
January 2022

What is the optimal lipid emulsion for preventing intestinal failure-associated liver disease following parenteral feeding in a rat model of short-bowel syndrome?

Pediatr Surg Int 2021 Feb 3;37(2):247-256. Epub 2021 Jan 3.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.

Purpose: Composite lipid emulsion (CLE) has been used for intestinal failure-associated liver disease (IFALD) to compensate for the disadvantages of soybean oil lipid emulsion (SOLE) or fish oil lipid emulsion (FOLE). However, the influence of its administration is unclear. We evaluated the effects of these emulsions on IFALD using a rat model of the short-bowel syndrome.

Methods: We performed jugular vein catheterization and 90% small bowel resection in Sprague-Dawley rats and divided them into four groups: control (C group), regular chow with intravenous administration of saline; and total parenteral nutrition co-infused with SOLE (SOLE group), CLE (CLE group) or FOLE (FOLE group).

Results: Histologically, obvious hepatic steatosis was observed in the SOLE and CLE groups but not the FOLE group. The liver injury grade of the steatosis and ballooning in the FOLE group was significantly better than in the SOLE group (p < 0.05). The TNF-α levels in the liver in the FOLE group were significantly lower than in the SOLE group (p < 0.05). Essential fatty acid deficiency (EFAD) was not observed in any group.

Conclusion: Fish oil lipid emulsion attenuated hepatic steatosis without EFAD, while CLE induced moderate hepatic steatosis. The administration of CLE requires careful observation to prevent PN-induced hepatic steatosis.
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http://dx.doi.org/10.1007/s00383-020-04802-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847428PMC
February 2021

The administration of hepatocyte growth factor prevents total parenteral nutrition-induced hepatocellular injury in a rat model.

Pediatr Surg Int 2021 Mar 3;37(3):353-361. Epub 2021 Jan 3.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.

Purpose: Total parenteral nutrition (TPN) sometimes induces parenteral nutrition-associated liver disease (PNALD). Hepatocyte growth factor (HGF) acts as a potent hepatocyte mitogen anti-inflammatory and antioxidant actions. We aimed to evaluate the effect of HGF on PNALD in a rat model of TPN.

Methods: A catheter was placed in the right jugular vein for 7-day continuous TPN. All rats were divided into three groups: TPN alone (TPN group), TPN plus intravenous HGF at 0.3 mg/kg/day [TPN + HGF (low) group], and TPN plus HGF at 1.0 mg/kg/day [TPN + HGF (high) group]. On day 7, livers were harvested and the histology, inflammatory cytokines and apoptosis were evaluated.

Results: Histologically, lipid droplets were apparent in the TPN group, but decreased in the TPN + HGF (low) and TPN + HGF (high) groups. The histological nonalcoholic fatty liver disease activity scores in the TPN + HGF (low) and TPN + HGF (high) groups were significantly lower than that in the TPN group (p < 0.01). There were no significant differences in the inflammatory cytokine levels of the three groups. The caspase-9 expression levels in the TPN + HGF (low) and TPN + HGF (high) groups were significantly decreased in comparison to that in the control group (p < 0.05).

Conclusion: The intravenous administration of HGF attenuated hepatic steatosis induced by 7-day TPN dose dependently.
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http://dx.doi.org/10.1007/s00383-020-04823-9DOI Listing
March 2021

Differential advantage of liver retraction methods in laparoscopic fundoplication for neurologically impaired patients: a comparison of three kinds of procedures.

Pediatr Surg Int 2020 May 20;36(5):591-596. Epub 2020 Mar 20.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan.

Aim Of The Study: Liver retraction during laparoscopic fundoplication is important for obtaining an optimal space. Several methods have been developed, but the risks and benefits are unclear. We compared three different approaches and evaluated their safety and utility.

Methods: Forty-three neurologically impaired patients who underwent laparoscopic fundoplication between 2005 and 2018 were classified into three groups: A, snake retractor method, n = 18; B, crural suture method, n = 13; C, needle grasper method, n = 12. Patients' characteristics and outcomes were reviewed.

Main Results: The liver retraction time was significantly shorter in group C than in A or B (p < 0.05). The operative times were shorter in groups B and C than in A. There were no significant differences in the liver enzyme levels. The liver enzyme levels increased temporarily but improved within a week. The C-reactive protein levels were significantly lower in group B than in A or C (p < 0.05).

Conclusions: The most convenient method was the needle grasper method, as the other two approaches create conflict with the operator's forceps. The crural suture method damages the liver less, but requires higher surgical skill levels. It is important to select the appropriate method according to the operator's skill and the patient's size and deformity.
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http://dx.doi.org/10.1007/s00383-020-04646-8DOI Listing
May 2020

Cecal diverticulitis: Two pediatric cases.

Pediatr Int 2019 Sep;61(9):931-933

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

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http://dx.doi.org/10.1111/ped.13940DOI Listing
September 2019

Novel effect of glucagon-like peptide-2 for hepatocellular injury in a parenterally fed rat model of short bowel syndrome.

Pediatr Surg Int 2019 Dec 25;35(12):1345-1351. Epub 2019 Sep 25.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.

Purpose: Short bowel syndrome (SBS) patients require long-term parenteral nutrition following massive bowel resection, which causes intestinal failure-associated liver disease (IFALD). Previous reports have shown that glucagon-like peptide-2 (GLP-2) resulted in the bowel adaptation for SBS. The aim of this study was to evaluate the effect of GLP-2 for IFALD in a parenterally fed rat model.

Methods: Using rat, a catheter was placed in the jugular vein, and 90% small bowel resection (SBR) was performed. Animals were divided into three groups: SBR and total parenteral nutrition (TPN) (SBS/TPN group), SBR and TPN plus GLP-2 at 1 µg/kg/h [SBS/TPN/GLP-2 (low) group], and SBR and TPN plus GLP-2 at 10 µg/kg/h [SBS/TPN/GLP-2 (high) group]. On day 13, the liver was harvested and analyzed by using nonalcoholic fatty liver disease (NAFLD) score.

Results: Histologically, hepatic steatosis in the SBS/TPN group and SBS/TPN/GLP-2 (high) group was observed. Both steatosis and lobular inflammation score in the SBS/TPN/GLP-2 (low) group were significantly lower compared with those in the other two groups (p < 0.05). Active NAFLD score in the SBS/TPN/GLP-2 (low) group was significantly lower compared with that in the SBS/TPN/GLP-2 (high) group (p < 0.01).

Conclusion: Low-dose GLP-2 intravenous administration improves hepatic steatosis of IFALD following in an SBS parenterally fed rat model.
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http://dx.doi.org/10.1007/s00383-019-04560-8DOI Listing
December 2019

Microvascular proliferation of the portal vein branches in the liver of biliary atresia patients at Kasai operation is associated with a better long-term clinical outcome.

Pediatr Surg Int 2019 Dec 21;35(12):1437-1441. Epub 2019 Sep 21.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan.

Aim Of The Study: We previously showed an increased number of smaller portal vein (PV) branches in the portal areas of liver biopsy specimens of biliary atresia (BA) patients. We evaluated the correlation between this histopathological feature and the prognosis.

Patients And Methods: Twenty-five consecutive patients with BA encountered between 2000 and 2012 were classified into three prognostic groups based on their postoperative outcomes: Excellent (n = 11) for native-liver survivors with a normal liver function, Good (n = 6) for native-liver survivors with liver dysfunction, and Poor (n = 8) for survivors after liver transplant or on a waiting list. Data from morphometrical analyses, including the fibrotic portal area, numbers of PVs, diameter and total area of PV branches, were statistically compared among the three groups.

Main Results: The number of PV branches per unit area of the whole-liver specimen in the poor prognostic group was significantly lower than that in the excellent group (3.1 ± 0.6 vs. 5.2 ± 2.0/mm, p = 0.03). There were no significant differences in the other parameters.

Conclusions: This is the first report on the relationships between morphometrically analyzed PV branches and the postoperative course in BA patients. The portal venous system is involved as the primary lesion in BA.
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http://dx.doi.org/10.1007/s00383-019-04579-xDOI Listing
December 2019

Impact and Characteristics of Forceps Manipulation of Three-Dimensional in Laparoscopic Hepaticojejunostomy Mimicking a Disease-Specific Simulator: A Comparison of Expert with Trainee.

J Laparoendosc Adv Surg Tech A 2019 Oct 20;29(10):1378-1382. Epub 2019 Sep 20.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

Various studies have shown the benefit of three-dimensional (3D) systems over two-dimensional (2D) systems in endoscopic surgery. However, few studies have focused on pediatric endosurgery. The purpose of this study was to assess the impact of 2D and 3D environments on the time taken and forceps manipulation by comparing experts and trainees using a laparoscopic hepaticojejunostomy simulator. We have developed a simulator of laparoscopic hepaticojejunostomy for congenital biliary dilatation. Seventeen participants of pediatric surgeons (4 experts and 13 trainees) performed hepaticojejunostomy using our simulator in both 2D and 3D environment. We evaluated the required time, total path length, and average velocities of bilateral forceps in both situations. Obtained results show the findings for the required time (seconds; 2D, experts: 810.43 ± 321.64 vs. trainees: 1136.02 ± 409.96,  = .17) (seconds; 3D, experts: 660.21 ± 256.48 vs. trainees: 1017 ± 280.93,  = .039), total path length of right forceps (mm; 2D, experts: 38838.23 ± 30686.63 vs. trainees: 52005.47 ± 31675.02,  = .48)(mm; 3D, experts: 24443.09 ± 12316.32 vs. trainees: 45508.09 ± 26926.27,  = .16), total path length of left forceps (mm; 2D, experts: 131635.54 ± 71669.94 vs. trainees: 245242.48 ± 130940.25,  = .48)(mm; 3D, experts: 88520.42 ± 56766.63 vs. trainees: 230789.75 ± 107315.85,  = .024), average velocities of right forceps (mm/second; 2D, experts: 44.80 ± 21.85 vs. trainees: 44.37 ± 18.92,  = .97) (mm/second; 3D, experts: 37.28 ± 16.49 vs. trainees: 42.58 ± 14.40,  = .54), average velocities of left forceps (mm/second; 2D, experts: 156.65 ± 38.69 vs. trainees: 202.58 ± 63.80,  = .20) (mm/second; 3D, experts: 125.64 ± 44.30 vs. trainees: 219.42 ± 43.82,  < .01). The experts performed more effectively when using the 3D system. Using 3D, the total path length of the left forceps of expert pediatric surgeons was significantly shorter than trainee pediatric surgeons, and the average velocities of the left forceps tip of expert pediatric surgeons was significantly slower than trainee pediatric surgeons. These results suggest that training of assisting hand is necessary for advanced pediatric endosurgery to avoid organ injury.
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http://dx.doi.org/10.1089/lap.2019.0211DOI Listing
October 2019

A Comparison of the Effectiveness Between Three Different Endoscopic Surgical Skill Training Programs for Medical Students Using the Infant Laparoscopic Fundoplication Simulator: A Randomized Controlled Trial.

J Laparoendosc Adv Surg Tech A 2019 Oct 11;29(10):1252-1258. Epub 2019 Sep 11.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

Training programs for developing laparoscopic suturing skills range from dry-box training to virtual simulator training. There are advantages and disadvantages to each training method; however, which training is best for medical students and young surgeons is unclear. The aim of this study was to compare the proficiency of medical students in acquiring laparoscopic suturing skills after various routes of short-term training: via a video, an expert teacher, or a virtual simulator. Seventeen medical students were registered and divided randomly into three groups: group receiving personal training while watching a training video (video group), group receiving training under the guidance of an expert (teaching group), and group receiving personal training with a virtual simulator (virtual group). The students practiced laparoscopic suturing and tying skills for 1 hour. Following their training, they performed the evaluation task of three sutures and ties using a laparoscopic fundoplication simulator. We developed a 1-year-old infant body model (body weight 10 kg) based on computed tomography data and established a pneumoperitoneum body model based on a clinical situation. The path length of the assistant forceps in the virtual group tended to be longer than in the other groups. The average acceleration of the assistant forceps in the virtual group was faster than in the other groups ( = .04). There were no significant differences in the other evaluation parameters. A long-term and combination training study should be performed to develop the best method for training medical students and inexperienced young surgeons.
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http://dx.doi.org/10.1089/lap.2019.0212DOI Listing
October 2019

Formation of Supramolecular Soft Materials from Amylosic Inclusion Complexes with Designed Guest Polymers Obtained by Vine-Twining Polymerization.

ACS Omega 2019 Apr 4;4(4):6331-6338. Epub 2019 Apr 4.

Department of Chemistry, Biotechnology, and Chemical Engineering, Graduate School of Science and Engineering, Kagoshima University, 1-21-40 Korimoto, Kagoshima 890-0065, Japan.

Amylose forms supramolecular inclusion complexes with polymeric guests in the phosphorylase-catalyzed enzymatic polymerization field, so-called "vine-twining polymerization". However, such inclusion complexes have not exhibited specific properties and processability as functional supramolecular materials. In this study, we found that amylosic inclusion complexes, which were obtained by vine-twining polymerization using a designed guest polymer, that is, an amphiphilic triblock copolymer poly(2-methyl-2-oxazoline--tetrahydrofuran--2-methyl-2-oxazoline), exhibited gel and film formation properties. The characterization results of the products suggested that enzymatically elongated amylose chains complexed with the polytetrahydrofuran block in the triblock copolymer. Accordingly, the outer poly(2-methyl-2-oxazoline) blocks constructed hydrophilic spaces among the inclusion complex segments. Furthermore, the presence of such outer blocks affected the lower regularity of crystalline alignment among the inclusion complex segments in the products. Such higher-order structures probably induced the formation of supramolecular soft materials, such as gels and films.
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http://dx.doi.org/10.1021/acsomega.9b00238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649246PMC
April 2019

Impact and characteristics of two- and three-dimensional forceps manipulation using laparoscopic hepaticojejunostomy mimicking a disease-specific simulator: a comparison of pediatric surgeons with gastrointestinal surgeons.

Pediatr Surg Int 2019 Oct 8;35(10):1051-1057. Epub 2019 Aug 8.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan.

Purpose: This study assessed the impact of 2D and 3D environments by comparing pediatric surgeons (PS) and gastrointestinal surgeons (GIS) using a laparoscopic hepaticojejunostomy simulator.

Methods: We developed a high-fidelity simulator of laparoscopic hepaticojejunostomy. Thirty-five participants (19 PS and 16 GIS) performed hepaticojejunostomy in both 2D and 3D environments. We evaluated the required time, total path length, and average velocities of bilateral forceps in both situations using the para-axial port layout.

Results: Regarding the participants' characteristics, the performance history of laparoscopic hepaticojejunostomy differed significantly between PS and GIS. In PS, the 3D environment did not markedly affect compared with 2D. In GIS, however, the 3D environment affected the time and movement of the right forceps. There were no significant differences in the time between PS and GIS in either environment. In both environments, the right-hand movement of the PS group was shorter and slower than that of the GIS group, but the left-hand movement was the opposite.

Conclusion: There were significant differences in forceps movement characteristics between the PS and GIS. The effects of a 3D environment could not be clarified in this study, because it may depend on the port layout used and the operative procedures.
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http://dx.doi.org/10.1007/s00383-019-04538-6DOI Listing
October 2019

The change over time in the postoperative bowel function in male anorectal malformation patients who underwent sacroperineal anorectoplasty and sacroabdominoperineal anorectoplasty.

Pediatr Surg Int 2019 Oct 7;35(10):1109-1114. Epub 2019 Aug 7.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima city, 890-8520, Japan.

Purpose: Many kinds of operative procedures have been proposed for anorectal malformation (ARM) patients. At our institution, sacroperineal or sacroabdominoperineal anorectoplasty (SP-SAP) have been performed from 1984 to 2007. The aim of this study is clarify the change over the time in the postoperative bowel function in male ARM patients.

Methods: Patient data were collected from 1984 to 2007. Fifty-two male patients with high- and intermediate-type ARM were enrolled. The patients' characteristics and bowel function were reviewed and analyzed retrospectively. The bowel function was evaluated according to the evacuation score (ES) of the Japan Society of ARM Study Group.

Results: The operative procedures were SP-SAP in 52 male patients. The total ES improved chronologically and significantly until 11 years of age. Regarding the clinical stratification of the ES, the ratio of "excellent" and "good" results was over 91.9% at 11 years of age. A satisfactory bowel movement score was achieved by 9 years of age. The constipation, incontinence and soiling scores improved slowly but continuously until 11 years of age.

Conclusion: The ES showed continuous improvement after a definitive operation. An understanding of the characteristics of improvement is very important in managing the postoperative bowel function in ARM patients.
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http://dx.doi.org/10.1007/s00383-019-04540-yDOI Listing
October 2019

The long-term health-related quality of life in patients operated for choledochal cyst.

Pediatr Surg Int 2019 May 14;35(5):539-546. Epub 2019 Feb 14.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.

Purpose: Late postoperative complications in choledochal cyst (CC) patients are severe problems that affect the quality of life (QOL). We evaluated the postoperative complications and health-related QOL (HRQOL) of CC patients ≥ 18 years of age.

Methods: From April 1984 to January 2018, 114 CC patients underwent definitive surgery at our institution. Seventy-nine patients reached ≥ 18 years of age. The HRQOL was assessed using the Japanese version of the SF-36v2. Eight health domain (physical functioning, role-physical, body pain, general health, role-emotional, vitality, mental health, and social functioning) scores and three component summary [physical component summary, mental component summary (MCS), and role-social component summary] scores were compared between the patients with and without complications (C [+] vs. C [-]).

Results: Thirty-five patients answered the questionnaires. Twelve patients had postoperative complications. Among the eight domains, the score of general health was significantly lower in C [+] patients than in C [-] patients (p = 0.0488). Among the three component scores, the MCS score in C [+] patients was lower than in C [-] patients without significance (p = 0.0953).

Conclusions: The HRQOL of CC patients ≥ 18 years of age was mostly acceptable. However, postoperative complications can impair the sense of well-being and affect the mental health.
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http://dx.doi.org/10.1007/s00383-019-04456-7DOI Listing
May 2019

Mode selective excitation of terahertz vibrations in single crystalline rubrene.

J Chem Phys 2019 Feb;150(5):054503

Graduate School of Science and Technology, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, Japan.

Organic molecular crystals have a variety of low frequency vibrational modes composed of intra- and inter-molecular oscillations. They are mixed intricately in the terahertz (THz) region. We are interested in the controllability of the vibrational energy distribution among such THz vibrational modes based on the femtosecond double-pulse excitation scheme. Single crystalline rubrene is prepared by physical vapor transport. The optical response of vibrational modes in the electric ground state of rubrene is detected by the ultrafast pump-probe reflectivity measurement at 90 K. Three oscillation modes at 3.20, 3.67, and 4.18 THz are detected, and we demonstrate selective enhancement and depletion of each mode by properly tuning the double-pulse delay. The amplitude of the selected vibrational mode is modulated between 0.149 and 1.87, where 1.0 corresponds to the amplitude excited with a single pump pulse. The double-pulse delay dependence of the observed vibrational amplitude is simulated based on the classical driven harmonic oscillator model, and the results reasonably reproduce our experimental signals. Such selective manipulation of the vibrational amplitude can be a potential tool to investigate the vibronic and electron-phonon couplings which plays an important role for the charge transport characteristics and various optoelectronic properties in organic molecular crystals.
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http://dx.doi.org/10.1063/1.5068732DOI Listing
February 2019

A Randomized Trial to Compare the Conventional Three-Port Laparoscopic Appendectomy Procedure to Single-Incision and One-Puncture Procedure That Was Safe and Feasible, Even for Surgeons in Training.

J Laparoendosc Adv Surg Tech A 2019 Mar 10;29(3):392-395. Epub 2018 Nov 10.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan.

Background: Single-incision laparoscopic surgery has emerged; however, the procedures might be complicated for trainees. We compared the clinical outcomes of conventional three-port laparoscopic appendectomy (CLA) and single-incision and one-puncture laparoscopic appendectomy (SIOPLA) by attending pediatric surgeons (APSs) and surgeons in training (SITs).

Materials And Methods: We reviewed the clinical outcomes of 72 randomized laparoscopic appendectomies that were consecutively performed by SITs and APSs for a 2-year period. The cases were categorized according to type of surgeon. Finally, 10 CLA and 18 SIOPLA procedures were performed by SITs, and 24 CLA and 20 SIOPLA procedures were performed by APSs. The operative time, blood loss, analgesic use, complications, and hospital stay were analyzed.

Results: There were no significant differences in any of the evaluation points between CLA and SIOPLA.

Conclusions: SIOPLA is not inferior operation to CLA, and the postoperative outcomes of SIOPLA were satisfactory. Thus, SIOPLA was safe and feasible for young surgeons to perform.
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http://dx.doi.org/10.1089/lap.2018.0195DOI Listing
March 2019

The effect of intravenous lipid emulsions and mucosal adaptation following massive bowel resection.

J Pediatr Surg 2018 Dec 1;53(12):2444-2448. Epub 2018 Oct 1.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima City, Japan. Electronic address:

Aims And Objectives: Fish oil (FO) lipid emulsion and a new lipid emulsion (SMOF) are important treatments for intestinal failure-associated liver disease. We evaluated the efficacy of FO and SMOF lipid emulsion on intestinal mucosal adaptation using a total parenteral nutrition (TPN)-supported rat model of short bowel syndrome.

Material & Methods: Sprague-Dawley rats underwent jugular vein catheterization and 90% small bowel resection and were divided into three groups: TPN with soy bean oil lipid emulsion (SO group), FO lipid emulsion (FO group), or SMOF (SMOF group). On day 13, the rats were euthanized, and the small intestine was harvested. The microscopic morphology and crypt cell proliferation rate (CCPR) were then evaluated.

Results: The villus height of the ileum in the SMOF group was significantly higher than in the SO group. The crypt depth of the intestine in the SMOF group was significantly lower than in the SO group. The CCPRs of the intestine in the FO and SMOF groups were both higher than in the SO group.

Conclusions: Lipid emulsion affected the bowel morphology, such as the mucosa as well as the intestinal smooth muscle. Further studies are needed to clarify the mechanisms.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.08.019DOI Listing
December 2018

Predictive factors affecting the prognosis and late complications of 73 consecutive cases of esophageal atresia at 2 centers.

Pediatr Surg Int 2018 Oct 6;34(10):1027-1033. Epub 2018 Aug 6.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.

Purpose: While the diagnosis and outcomes of esophageal atresia (EA) have improved, associated anomalies, the management of late complications and growth remain major issues. We analyzed factors that affected the prognosis, late complications and growth.

Methods: We retrospectively reviewed EA patients treated at two centers from 1984 to 2016. Patient characteristics, complications (gastroesophageal reflux [GER], anastomotic stenosis, tracheomalacia, dysphagia) and growth were evaluated.

Results: Seventy-three EA patients were treated (overall survival rate:80.8%). The mean birth weight was 2514 ± 509 g in the surviving group, and 2453 ± 567 g in the fatal group excluded chromosomal abnormality (p = 0.76). Cardiac and chromosomal anomalies significantly affected mortality. Postoperative GER and anastomotic stenosis each occurred in 39% of the patients. Only GER was significantly affected by the Gross classification. The standard deviation (SD) values of the EA patients' growth were all lower than in the normal population. The SD of body weight was significantly lower in patients with extremity anomalies.

Conclusions: Associated cardiac and chromosomal anomalies significantly affected the prognosis. GER and anastomotic stenosis were the most common late complications. The growth of the surviving cases was insufficient. These factors will help optimize the therapeutic strategies and postoperative management for EA.
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http://dx.doi.org/10.1007/s00383-018-4326-1DOI Listing
October 2018

Ghrelin stimulates intestinal adaptation following massive small bowel resection in parenterally fed rats.

Peptides 2018 08 30;106:59-67. Epub 2018 Jun 30.

Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Japan. Electronic address:

Background: Since short bowel syndrome (SBS) patients face life-threatening conditions, the development of therapeutic strategies to induce intestinal adaptation has been investigated. Ghrelin, a ligand of growth hormone (GH) secretagogue-receptor that stimulates the release of GH and insulin like growth factor-1 (IGF-1), has several pleiotropic effects. We investigated whether ghrelin induces intestinal adaptation in parenterally fed rats with SBS.

Methods: Sprague-Dawley rats underwent venous catheterization and were divided into 3 groups: those receiving 90% small bowel resection while leaving the proximal jejunum and distal ileum (90% SBR) with TPN (SBS/TPN group), those receiving 90% SBR with TPN + ghrelin (SBS/TPN/ghrelin group), and those receiving sham operation and fed chow (sham group). Ghrelin was administered intravenously at 10 μg/kg/day. On Day 13, the rats were euthanized and the small intestine harvested, and the histology and crypt cell proliferation rates (CCPR), apoptosis, and nutrient transporter protein levels were analyzed and the plasma hormones were measured.

Results: The villus height and crypt depth of the ileum in the SBS/TPN/ghrelin group were significantly higher than in the SBS/TPN group. The CCPR of the jejunum and the ileum significantly increased by the administration of ghrelin; however, the apoptosis rates did not significantly differ between the SBS/TPN and SBS/TPN/ghrelin groups. Significant differences did not exist in the plasma IGF-1 and nutrient transporter protein levels among three groups.

Conclusions: The intravenous administration of ghrelin stimulated the morphological intestinal adaptation of the ileum to a greater degree than the jejunum due to the direct effect of ghrelin.
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http://dx.doi.org/10.1016/j.peptides.2018.06.009DOI Listing
August 2018

The bowel function and quality of life of Hirschsprung disease patients who have reached 18 years of age or older - the long-term outcomes after undergoing the transabdominal soave procedure.

J Pediatr Surg 2017 Dec 2;52(12):2001-2005. Epub 2017 Sep 2.

Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan. Electronic address:

Background/purpose: Hirschsprung disease (HD) is considered curable, but the postoperative bowel function is not always satisfactory. In this study, we evaluated the general condition, bowel function, and social performance in adults who were older than 17years of age who had undergone definitive operations in childhood.

Method: From 1984 to 2016, 110 patients with HD underwent definitive surgery at our institute. Sixty-three patients who had undergone the transabdominal Soave procedure reached 18years of age. Their present status and symptoms, anorectal function, genitourinary function, and social performance were evaluated during the clinical follow-up via a questionnaire survey.

Result: The mean age of the questionnaire respondents was 25.0 (19-37) years. The bowel function was mostly good. However, 56% of patients had abdominal pain more than once a week. Regarding evacuation symptoms, incontinence and soiling occurred in 18.7%. Among the respondents 33.3% were married, and 60% of those who were married had children. The respondents had achieved success in their education and professional careers.

Conclusion: The bowel function of most patients was satisfactory, although some had chronic abdominal symptoms. Pediatric surgeons should continue trying to achieve complete bowel function after definitive surgery of HD.

Type Of Study: Prospective Cohort Study.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1016/j.jpedsurg.2017.08.036DOI Listing
December 2017
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