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Nissen fundoplication (NF) is the most commonly used surgical treatment for persistent gastroesophageal reflux disease (GERD). We introduced to the alternative Thal fundoplication (TF) (partial anterior wrapping) in 1998. The purpose of this paper is to review and report on the effectiveness of TF in our department.

We retrospectively analyzed cases of 281 patients who underwent TF for GERD at our hospital from 1998 to 2019.

Average age, 16.3 ± 18.1years; average body weight, 21.0 ± 16.0kg; average operative time, 89.1 ± 43.0min; average volume of bleeding, 11.6 ± 29.2g; enteral feeding commenced after an average of 3.4 ± 1.3 postoperative days (PODs), and average postoperative full enteral feeding was 6.3 ± 1.4 PODs. Five patients (1.8%) had Clavien-Dindo classification III or higher; average hospital stay duration was 10.3 ± 6.0days, with symptom recurrence affecting 17 patients (6.1%).

TF may be an effective and simple treatment for GERD that has few recurrences and avoids complications common to NF, but further studies to compare it with other techniques are needed.

TF may be an effective and simple treatment for GERD that has few recurrences and avoids complications common to NF, but further studies to compare it with other techniques are needed.

This study aimed to investigate the negative effects of intestinal obstruction for jaundice-free native liver survival after Kasai portoenterostomy (PE) for biliary atresia (BA).

We retrospectively reviewed the records of patients who underwent PE for BA between 2006 and 2019. We evaluated the postoperative morbidity of intestinal obstruction for up to 2years after PE and the effects of intestinal obstruction on jaundice-free native liver survival. On the basis of their initial operation, patients were divided into open portoenterostomy (Open-PE) and laparoscopic portoenterostomy (Lap-PE) groups, and morbidity was compared.

Of the 87 patients reviewed, 6 (6.9%) patients developed postoperative intestinal obstruction and underwent surgery to relieve the obstruction. The morbidity of early postoperative intestinal obstruction was 1.68 per 10,000 person days. The jaundice-free native liver survival rate among patients who once achieved jaundice-free status after PE was significantly lower in the patients with intestinal obstruction compared to in those without intestinal obstruction (0% vs. 73.8%; RR = 3.81, p = 0.007). No significant differences were seen in postoperative intestinal obstructions between the Open-PE and Lap-PE groups (p = 0.242).

Intestinal obstruction negatively impact jaundice-free native liver survival, even in patients who once achieved jaundice-free status after PE for BA.

Intestinal obstruction negatively impact jaundice-free native liver survival, even in patients who once achieved jaundice-free status after PE for BA.

Foreign body (FB) ingestion is increasingly common in children, and ingestion of multiple magnetic FBs can cause serious injuries. This study aimed to identify the clinical features and management options of such cases.

A retrospective review was conducted of 35 pediatric patients diagnosed as having ingested multiple magnetic FBs.

The main clinical manifestations were abdominal pain, vomiting, and fever. Of the 35 patients, 6 (17.1%) were conservatively treated and the remaining 29 (82.9%) were surgically treated. Of those who were surgically treated, 26 underwent exploratory laparotomy and 3 underwent laparoscopic surgery that was switched to open surgery. Intestinal structure and function were restored without complications in patients who underwent successful perforation repair following removal of multiple magnetic FBs.

Ingestion of multiple magnetic FBs can lead to intestinal perforations, bowel strangulation, and necrosis. Accordingly, timely diagnosis and effective management of multiple magnetic FB ingestions in pediatric patients are of paramount importance to reduce further complications.

Ingestion of multiple magnetic FBs can lead to intestinal perforations, bowel strangulation, and necrosis. Accordingly, timely diagnosis and effective management of multiple magnetic FB ingestions in pediatric patients are of paramount importance to reduce further complications.

The optimal timing of surgery for congenital diaphragmatic hernia (CDH) is controversial. We aimed to validate our protocol for the timing of CDH repair using the quantified patent ductus arteriosus (PDA) flow pattern.

This retrospective comparative study analyzed patients with a prenatal diagnosis of isolated CDH between 2007 and 2020. We defined the “LR ratio” as the percentage of velocity-time integral (VTI) of the left-to-right flow of PDA against overall VTI on echocardiography. Since 2010, we followed the decision criterion of performing surgery when LR ratio of > 50% has been achieved in the patients (protocol group). The protocol group (2010-2020) was compared with the historical control group (2007-2009).

The average age at surgery was 104.1 ± 175.9 and 37.3 ± 30.6h in the control and protocol groups, respectively (p = 0.11). Survival rate (88.9% vs. 95.0%, p = 0.53) and the rate of worsening of pulmonary hypertension within 24h after surgery (22.2% vs. 10.0%, p = 0.57) were not different between the groups. The protocol group had a significantly shorter duration of tracheal intubation (26.9 ± 21.1 vs. 13.3 ± 9.5days, p = 0.03).

Our decision criterion might have the advantage of facilitating early and safe surgery for patients with CDH.

Our decision criterion might have the advantage of facilitating early and safe surgery for patients with CDH.

Video-assisted thoracoscopic (VATS) resection of CPAM in children is an established, albeit controversial strategy for its management. We report a 10-year single center experience.

All children underwent VATS (2008-2017) and their current status was reviewed. Patients were grouped ‘symptomatic-P’ (if parents reported recurrent lower respiratory tract infections etc.) or ‘symptomatic-S’ (neonates presenting with respiratory distress/difficulty) or ‘asymptomatic’.

73 children, aged 10m (4d-14yrs) underwent VATS; a neonate as an emergency (‘symptomatic-S’) and all others electively. The lesion was unilateral in all but one case. Histologically none were malignant. selleck inhibitor Of the elective 72 cases, 7 (10%) required conversion to open thoracotomy. Twenty (27.7%) were ‘symptomatic-P’ and the duration of surgery when compared to ‘asymptomatic’ children was longer 269 (range 129-689) versus 178 (range 69-575) minutes (P = 0.01). Post operatively, 8 children (11%) had a grade III/IV (Clavien-Dindo) complication; persistent air leak/pneumothorax (n = 5), chylothorax (n = 1), pleural effusion (n = 1) and seizure/middle cerebral artery thrombosis (n = 1).