Hidemi Takasu

Umbilicoplasty with 3 triangular skin flaps and excised diamond-shaped skin flap

PURPOSE In cases of large umbilical hernias, standard surgical techniques have proven inadequate for diminishing the diameter of the umbilicus. We have modified the 3- and 4-triangular-skin-flap techniques to diminish the diameter of the umbilicus and achieve a cosmetically acceptable umbilicus. MATERIALS AND METHODS Umbilicoplasty was performed in 149 children (median age, 2.5 years; range, 3 months-10 years) between 2003 and 2008. We created 4 skin flaps 1.5 cm in length on the umbilicus and excised the cranial diamond-shaped skin flap. After closure of the fascial defect, the diameter of the umbilicus was diminished by suturing the opened cranial part of the diamond-shaped skin flap vertically. The tips of the 3 remaining flaps were then anchored to the closed fascia. RESULTS Postoperatively, granulation tissue occurred in 18 cases (12%), transient erythema of a flap in 15 cases (10%), and bulging of a skin flap in 15 cases (10%). These complications were reduced by suturing adjoining skin flaps. No recurrent hernias were encountered. The postoperative umbilical appearance was satisfactory in all cases. CONCLUSION This surgical technique is effective for diminishing the diameter of the umbilicus and creating a cosmetically acceptable shaped umbilicus, even for large umbilical hernias.

A preliminary report on the significance of excessively long segment congenital hypoganglionosis management during early infancy

BACKGROUND/PURPOSE Excessively long segment of congenital hypoganglionosis is rare, and therapeutic strategies to treat this disorder are not well established. The purpose of this study is to describe the significance of management in the neonatal and early infancy period. PATIENTS AND METHODS Four patients (aged 1-4 years) with hypoganglionosis were selected for this study, of which 3 were treated at our hospital. In the initial treatment of 3 cases, an intraoperative pathological diagnosis was made on the basis of findings from simultaneous biopsies taken from the jejunum and sigmoid colon. Retrospective reviews of these patients were performed. RESULTS Initial double-barrel jejunostomy at less than 50 cm from the ligament of Treitz allowed patients to start oral nutrition within a week following surgery. Subsequent refashioning of the initial jejunostomy to the Bishop-Koop type was performed at 3 to 6 months of age. Intravenous hyperalimentation was required to meet less than 50% of nutritional requirements, and patients were able to maintain their body weight within 1.5 SD of the normal mean body weight. Liver function test results were also within normal limits in the 3 patients treated at our hospital. CONCLUSION Early diagnosis and treatment may help improve the management of patients in the early stages of hypoganglionosis.

Wide variation in anal sphincter muscles in cases of high- and intermediate-type male anorectal malformation

PurposeThe distribution of sphincter muscle complex in anorectal malformation (ARM) needs to be investigated on a case-by-case basis. This study was undertaken to demonstrate the differences in the anal sphincter muscles between patients with the same type of ARM. Computed tomography (CT) data from cases of high- and intermediate-type male patients with ARM were reviewed using three-dimensional (3D) image analysis.Materials and methodsTwenty-seven male patients with ARM (18 high and 9 intermediate) before anorectoplasty were assessed using multidetector-row helical CT (MRH-CT). A 3D reconstruction was made using volume rendering method. The multi-dimensional sections of the 3D reconstructed images of the pelvic muscles were then analyzed and compared with schematic drawings from the literature.ResultsThe sphincters in the high and intermediate types of ARM could be divided into five groups. In 13 out of 18 cases in the high type and 7 out of 9 cases in the intermediate type, images of the sphincter muscles appeared different from schematic drawings appearing in the literature.ConclusionIn both high and intermediate types of ARM, more than 2/3 of cases demonstrated unexpectedly displaced and deformed hypoplastic sphincters. Therefore, we recommend that variations in anal sphincter should be investigated on an individual basis prior to surgery.

Unexpectedly deformed anal sphincter in low-type anorectal malformation.

PURPOSE The sphincter muscles in anorectal anomalies, which do not appear in the surgical field, cannot be described adequately. Details of the anal sphincter in low-type anorectal malformations were investigated using 3-dimensional (3D) image analysis. PATIENTS AND METHODS Thirty patients (10 males and 20 females) with low-type anorectal malformation were investigated with multidetector-row helical computed tomography. An image of the anorectal part was obtained with a slice thickness of 1 mm and a reconstruction pitch of 0.5 mm. A 3D reconstruction on a personal computer was made with a volume rendering method assisted by our own software (NewVES). RESULTS Very thin vertical fibers (VFs) were observed behind the fistula in almost half of the low-type cases. They did not wrap the distal end of the fistula. The 3D images of these sphincters were different in each case. DISCUSSION The fistula was dislocated forward from the deformed hypoplastic sphincter. We suggest that surgical mobilization of the anorectum into the center of the hypoplastic sphincter would be difficult using the cut back or Potts methods. CONCLUSION The choice of surgical method should take into consideration the displaced and deformed hypoplastic anal sphincter.

Cinematic magnetic resonance enterography for non-organic abdominal pain in infants and children.

Recurrent non‐organic abdominal pain is the most commonly diagnosed medical problem in children. However, excluding small bowel disease remains a challenge. We evaluated our exclusion criteria for organic small intestinal diseases in pediatric patients with recurrent non‐organic abdominal pain using cinematic magnetic resonance (cine‐MR) enterography.