Pediatric Surgery

Mikihiro Inoue

  (井上 幹大)

Profile Information

Affiliation
Professor, Department of Pediatric Surgery, Fujita Health University

Contact information
mikihiro.inouefujita-hu.ac.jp
Researcher number
30422835
J-GLOBAL ID
201901006486066222
researchmap Member ID
B000363489

Education

 2

Papers

 175
  • Hajime Uchida, Masato Shinkai, Hiroomi Okuyama, Takehisa Ueno, Mikihiro Inoue, Toshihiro Yasui, Eiso Hiyama, Sho Kurihara, Yasunaru Sakuma, Yukihiro Sanada, Akinobu Taketomi, Shohei Honda, Motoshi Wada, Ryo Ando, Jun Fujishiro, Mariko Yoshida, Yohei Yamada, Hiroo Uchida, Takahisa Tainaka, Mureo Kasahara
    Journal of pediatric surgery, 59(9) 1791-1797, Sep, 2024  
    BACKGROUND: Although congenital portosystemic shunts (CPSSs) are increasingly being recognized, the optimal treatment strategies and natural prognosis remain unclear, as individual CPSSs show different phenotypes. METHODS: The medical records of 122 patients who were diagnosed with CPSSs at 15 participating hospitals in Japan between 2000 and 2019 were collected for a retrospective analysis based on the state of portal vein (PV) visualization on imaging. RESULTS: Among the 122 patients, 75 (61.5%) showed PV on imaging. The median age at the diagnosis was 5 months. The main complications related to CPSS were hyperammonemia (85.2%), liver masses (25.4%), hepatopulmonary shunts (13.9%), and pulmonary hypertension (11.5%). The prevalence of complications was significantly higher in patients without PV visualization than in those with PV visualization (P < 0.001). Overall, 91 patients (74.6%) received treatment, including shunt closure by surgery or interventional radiology (n = 82) and liver transplantation (LT) or liver resection (n = 9). Over the past 20 years, there has been a decrease in the number of patients undergoing LT. Although most patients showed improvement or reduced progression of symptoms, liver masses and pulmonary hypertension were less likely to improve after shunt closure. Complications related to shunt closure were more likely to occur in patients without PV visualization (P = 0.001). In 25 patients (20.5%) without treatment, those without PV visualization were significantly more likely to develop complications related to CPSS than those with PV visualization (P = 0.011). CONCLUSION: Patients without PV visualization develop CPSS-related complications and, early treatment using prophylactic approaches should be considered, even if they are asymptomatic. LEVEL OF EVIDENCE: Level III.
  • Soichi Shibuya, Irene Paraboschi, Stefano Giuliani, Takafumi Tsukui, Andreea Matei, Maricarmen Olivos, Mikihiro Inoue, Simon A Clarke, Atsuyuki Yamataka, Augusto Zani, Simon Eaton, Paolo De Coppi
    Pediatric surgery international, 40(1) 182-182, Jul 9, 2024  
    PURPOSE: Previous studies have shown a higher recurrence rate and longer operative times for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) compared to open repair (OR). An updated meta-analysis was conducted to re-evaluate the surgical outcomes of TR. METHODS: A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588). RESULTS: Fourteen studies were selected for quantitative analysis, including a total of 709 patients (TR: 308 cases, OR: 401 cases). The recurrence rate was higher [Odds ratio: 4.03, 95% CI (2.21, 7.36), p < 0.001] and operative times (minutes) were longer [Mean Difference (MD): 43.96, 95% CI (24.70, 63.22), p < 0.001] for TR compared to OR. A significant reduction in the occurrence of postoperative bowel obstruction was observed in TR (5.0%) compared to OR (14.8%) [Odds ratio: 0.42, 95% CI (0.20, 0.89), p = 0.02]. CONCLUSIONS: TR remains associated with higher recurrence rates and longer operative times. However, the reduced risk of postoperative bowel obstruction suggests potential long-term benefits. This study emphasizes the importance of meticulous patient selection for TR to mitigate detrimental effects on patients with severe disease.
  • Ryusuke Nambu, Takahiro Kudo, Nao Tachibana, Hirotaka Shimizu, Tatsuki Mizuochi, Sawako Kato, Mikihiro Inoue, Hideki Kumagai, Takashi Ishige, Reiko Kunisaki, Atsuko Noguchi, Toshifumi Yodoshi, Shin-Ichiro Hagiwara, Shigeo Nishimata, Fumihiko Kakuta, Takeshi Saito, Itaru Iwama, Yuri Hirano, Toshiaki Shimizu, Katsuhiro Arai
    Journal of gastroenterology and hepatology, 39(2) 312-318, Dec 6, 2023  
    BACKGROUND AND AIM: Even with increasing numbers of biologic agents available for management of ulcerative colitis (UC), infliximab (IFX) retains an important place in treatment of pediatric patients with this disease. As few reports have addressed outcomes in pediatric UC patients who had to discontinue IFX, we examined clinical course and prognosis after IFX failure in pediatric UC. METHODS: A prospective cohort study of pertinent cases enrolled in the Japanese Pediatric Inflammatory Bowel Disease Registry between 2012 and 2020 was conducted to determine outcomes for pediatric UC patients who received IFX but required its discontinuation during follow-up (IFX failure). RESULTS: Of the 301 pediatric UC patients in the registry, 75 were treated with IFX; in 36 of these, IFX was discontinued during follow-up. Severity of UC at onset and absence of concomitant immunomodulator therapy were significant risk factors for IFX failure (P = 0.005 and P = 0.02, respectively). The cumulative colectomy rate after IFX failure was 41.3% at 1 year and 47.5% at 2 years. Colectomy was significantly more frequent when IFX was discontinued before June 1, 2018, than when IFX was discontinued later (P = 0.013). This difference likely involves availability of additional biologic agents for treatment of UC beginning in mid-2018 (P = 0.005). CONCLUSION: In pediatric UC patients, approximately 50% underwent colectomy during a 2-year interval following IFX failure. Prognosis after IFX failure appeared to improve with availability of new biologic agents and small-molecule drugs in mid-2018.
  • Mika Murayama, Mikihiro Inoue, Atsuki Naoe, Toshihiro Yasui, Tatsuya Suzuki
    Clinical journal of gastroenterology, 16(5) 685-688, Oct, 2023  
    An 11-year-old girl presented with recurrent right lower quadrant (RLQ) pain. There was no evidence of inflammation and appendiceal swelling except at the initial onset. The repeated presence of a small amount of ascites at the time of abdominal pain triggered the performance of exploratory laparoscopy. Intraoperative examination revealed a non-inflamed, unswollen appendix with a cord-like atretic segment at the middle part and an appendectomy was performed. At 46 months follow-up, she remained asymptomatic. In patients with recurrent RLQ pain of unknown cause, it is necessary to consider diagnostic laparoscopy while keeping appendiceal atresia in mind as a differential diagnosis.
  • Yuhki Koike, Chengzeng Yin, Yuki Sato, Yuka Nagano, Akira Yamamoto, Takahito Kitajima, Tadanobu Shimura, Mikio Kawamura, Kohei Matsushita, Yoshinaga Okugawa, Keishiro Amano, Yoshiki Okita, Masaki Ohi, Mikihiro Inoue, Keiichi Uchida, Masahiro Hirayama, Yuji Toiyama
    Surgery today, 54(4) 347-355, Aug 23, 2023  
    PURPOSE: To determine the methylation level of the miR-124 promoter in non-neoplastic rectal mucosa of patients with pediatric-onset ulcerative colitis (UC) to predict UC-associated colorectal cancer (UC-CRC). METHODS: Between 2005 and 2017, non-neoplastic rectal tissue specimens were collected from 86 patients with UC, including 13 patients with UC-CRC; cancer tissues were obtained from the latter group. The methylation status of the miR-124 promoter was quantified using bisulfite pyrosequencing and compared between pediatric- and adult-onset UC patients. RESULTS: Patients with pediatric-onset UC experienced a significantly shorter disease duration than those with adult-onset UC. The levels of miR-124 promoter methylation in non-neoplastic rectal mucosa were positively correlated with the age at the diagnosis and duration of UC. The rate of increase in miR-124 methylation was accelerated in patients with pediatric-onset UC compared to those with adult-onset UC. Furthermore, the miR-124 methylation levels in non-neoplastic rectal mucosa were significantly higher in patients with UC-CRC than in those with UC alone (P = 0.02). A receiver operating characteristic analysis revealed that miR-124 methylation in non-neoplastic tissue discriminated between patients with pediatric-onset UC with or without CRC. CONCLUSION: miR-124 methylation in non-neoplastic rectal mucosa may be a useful biomarker for identifying patients with pediatric-onset UC who face the highest risk of developing UC-CRC.

Misc.

 653
  • 村山 未佳, 安井 稔博, 井上 幹大
    小児外科, 56(2) 159-162, Feb, 2024  
  • 井上 幹大
    小児外科, 56(1) 45-48, Jan, 2024  
    <文献概要>はじめに 本稿では,噴門形成術の最も代表的な術式であるNissen法におけるラップ形成と縫合・結紮のポイントについて解説する。逆流を防止するという噴門形成術の目的に直接的に関わるパートであり,技術認定に合格するうえでもしっかりと術式を理解しておく必要がある。
  • 直江 篤樹, 井上 幹大, 鈴木 達也
    小児外科, 55(7) 704-707, Jul, 2023  
  • 井上 幹大
    小児科診療, 86(4) 451-455, Apr, 2023  
    <文献概要>▼内科的治療の進歩により外科治療が必要となる割合は減少傾向にある.▼内科的治療を引き伸ばして患児のQOLを損なわないよう,適切なタイミングで外科へ相談することが大切である.▼潰瘍性大腸炎に対する標準術式は大腸全摘,回腸嚢肛門(管)吻合術である.▼クローン病の腸管病変に対しては,将来,短腸症候群にならないための術式選択が重要である.▼クローン病の肛門病変に対する外科的治療の目的は肛門機能の保持である.
  • 井上 幹大
    小児科診療, 86(春増刊) 659-661, Apr, 2023  
    <文献概要>小児において肛門周囲膿瘍,痔瘻を発症するのは乳児期が多く,日常的に遭遇する頻度は高い.感染をくり返すことはあるが,多くは保存的治療や切開排膿を行いながら経過観察することで1歳頃までに治癒する.まれに炎症性腸疾患や免疫異常などが原因となっている場合があることに注意して診療をすすめる必要がある.

Research Projects

 14