Optimal Surgical Method and Timing for Low-birth-weight Esophageal Atresia Babies: Multi-institutional Observational Study.

AIM OF THE STUDY: Previous research has shown that low birth weight is one of the risk factors for esophageal atresia. However, there remains a paucity of evidence on the timing and the treatment method. METHOD: Data were collected using a multi-institutional observational study in 11 hospitals that performed surgeries on esophageal atresia babies whose birth weights were ≤1500 g from 2001 to 2020. RESULTS: Of the 46 patients analyzed, median birth weight was 1233 (IQR 1042-1412) g. Within 46 cases, 19 (41%) underwent definitive esophageal anastomosis at the median of age in 8 (IQR 2-101) days. Thirteen out of 19 experienced either closure of tracheoesophageal fistula, gastrostomy, or esophageal banding at the first operation, followed by esophageal anastomosis. Seven infants, including four cases of <1000 g, underwent anastomosis after one month of age to wait for weight gain (variously 2-3000 g). Twenty-one out of 27 infants (78%) who did not receive anastomosis died within one year of age, including 21 (78 %) with major cardiac anomalies and 24 (89%) with severe chromosomal anomalies (trisomy 18). Six survivors in this group, all with trisomy 18, lived with palliative surgical treatments. CONCLUSION: In our study, the definitive esophageal anastomosis was effective either at the first operation or as a later treatment after gaining weight. Although having severe anomalies, some infants receive palliative surgical treatments, and the next surgery was considered depending on their condition. EVIDENCE LEVEL: II.

Transumbilical Repair for Umbilical Hernia: A New Technique.

Although there are many reports on surgical repair for umbilical hernia, there is no standard procedure at present. Since 2012, we have performed surgery with transumbilical repair using an original procedure. With this procedure, a longitudinal incision is made in the umbilicus, and the fascial defect is closed. Excess skin is excised at a fixed length. The fascia and dermis are sutured vertically over a length of 15 mm. A total of 424 patients with pediatric umbilical hernia who underwent this procedure between September 2012 and December 2020 were reviewed. The mean operative duration was 52 minutes. All patients were followed up to 6 months after surgery. Postoperative complications included infection in 15 patients and wound granulation in 5 patients. The morphology of the umbilicus is natural and satisfying. We conclude that this procedure is safe and simple and the results are satisfactory.

The necessity of nighttime appendectomies: Is appendicitis an emergency?

BACKGROUND: In our institution, we avoid emergency nighttime appendectomies, instead performing the surgery during daylight hours the following day. We examined whether emergency or early appendectomies affect the outcome of patient morbidity. MATERIALS AND METHODS: Medical records of children treated for appendicitis between 2010 and 2012 were retrospectively reviewed. Outcomes were compared between Group 1, defined as those patients who presented to the hospital during the day and underwent appendectomy on the same day and Group 2, defined as those patients who presented to the hospital at night and underwent appendectomy the next day. Incidences of perforation at surgery, operative time, complications and length of stay were analysed. Cases with perforation were also analysed to determine if the perforations could have been identified preoperatively. RESULTS: A total of 74 patients met the study criteria, including 41 and 33 in Groups 1 and 2, respectively. There were no significant differences in the incidence of perforation at surgery, operative time, complications and length of stay. A total of nine cases of perforation were identified during surgery, and there were no significant differences in the pre-operative characteristics between perforated and non-perforated cases. CONCLUSIONS: The results of this study indicate that early appendectomy is safe and did not increase patient morbidity. We, therefore, recommend performing appendectomies in the daytime.

Single-stage operation for perforated choledochal cyst.

BACKGROUND: The option of either single- or two-staged cyst excision has been proposed for perforated choledochal cysts (CCs), but which of the two methods is more effective remains controversial. We examined the complications and short-term outcomes of single-stage excision of perforated and non-perforated CCs. METHODS: The medical records of patients treated for CCs from 2003 to 2016 were retrospectively reviewed. Outcomes were compared between patients with perforated CCs (Group A) and non-perforated CCs (Group B). The operative time, intraoperative bleeding, length of stay, and postoperative complications were analyzed. RESULTS: Group A comprised 6 patients (2 males, 4 females; mean age, 29months), and Group B comprised 26 patients (2 males, 24 females; mean age, 41months). All patients underwent single-stage complete excision with Roux-en-Y hepaticojejunostomy. There were no significant differences in the operative time, bleeding, and/or length of stay. There were no operative deaths or complications such as anastomosis leakage or postoperative cholangitis, but a pancreatic fistula developed in one patient in Group A and two in Group B. CONCLUSION: Single-stage excision for a perforated CC is feasible if the patient's condition is stable. LEVELS OF EVIDENCE: Treatment Study, LEVELIII.

Near Tetraploidy Acute Myeloid Leukemia in Long-term Remission with Persistent Clonal Hematopoiesis with del(20)(q12q13).

Patients with near tetraploidy/tetraploidy (NT/T)-acute myeloid leukemia (AML) are rare and generally show poor survival. A 62-year-old man was referred to our hospital with pancytopenia. A bone marrow examination revealed the proliferation of extremely large blasts, and led to the diagnosis of AML M0. A cytogenetic analysis showed an NT-karyotype of 91, XXYY, -5, add(18)(p21),del(20)(q12q13) ×2. Complete remission was achieved with single remission induction chemotherapy. Although consolidation chemotherapies were not available because of his critical condition, he remained in remission and survived for more than 40 months without cytopenia. However, repeated bone marrow examinations showed persistent clonal hematopoiesis with del(20)(q12q13) without apparent myelodysplasia.

The Usefulness of Combined B Mode and Doppler Ultrasonography to Guide Treatment of Appendicitis.

Introduction We have succeeded in classifying the severity of appendicitis by evaluating the structure of the submucosal layer and blood flow in the appendix wall with ultrasonography (US). Here, we propose a new preoperative classification system to guide treatment strategy. Materials and Methods Between February 2005 and December 2011, a total of 440 acute appendicitis cases were diagnosed, and 407 met inclusion criteria for this study. US and Doppler findings were used to classify cases as Grade I, IIa, IIb, III, or appendiceal mass. Grades I and IIa were treated conservatively without antibiotics. Appendectomy for Grades IIb and III and interval appendectomy for appendiceal mass were performed. Results Of 407 cases, 38 were Grade I, 132 were Grade IIa, 130 were Grade IIb, 57 were Grade III, and 50 were appendiceal mass. Improvement occurred without antibiotics in 37 (97.3%) Grade I and 129 (97.7%) Grade IIa cases. Recurrence occurred postdischarge in 9 (23.6%) Grade I and 35 (26.5%) Grade IIa cases. All Grades IIb and III patients had gangrenous or phlegmonous appendicitis. There were no negative appendectomies. Conclusion Even if US findings reveal swelling or an irregular submucosal layer, when power Doppler identifies abundant blood flow, inflammation may improve spontaneously. Decreased appendiceal wall blood flow indicates irreversible necrotic change. Doppler and B-mode US used together improve acute appendicitis treatment.

Intramural tracheal bronchogenic cyst: a case report.

Intramural bronchogenic cysts are extremely rare. We describe the case of an intramural bronchogenic cyst in a 2 year old boy who underwent tracheal resection and end-to-end anastomosis.