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Background Esophageal atresia (EA), tracheoesophageal fistula (TEF), or both is a complicated problem. The purpose of this study was to evaluate the outcomes and postoperative complications in patients with EA/TEF who were admitted to our hospital. Methods In total, 15 patients were enrolled from 1994 to 2003, including 8 males and 7 females. Patient demographics, associated anomalies, and outcomes were analyzed. Results The most common variant was EA with a distal TEF (type C), which occurred in 12 patients (80%). The latter had associated congenital anomalies, and cardiac anomalies were the most frequent, occurring in 8 patients (53.3%). Of the 6 cases who had life-threatening anomalies, 4 (66.7%) died, and of the 9 cases who had no life-threatening anomalies, 2 (22.2%) died. Tracheomalacia and/or stenosis were diagnosed in 8 patients (66.7%) postoperatively. Though 3 of the 4 cases who suffered from dying spell received intratracheal stent implantation, 2 cases still died. Conclusion The survival rate of the patients with EA/TEF is influenced mainly by associated life-threatening anomalies. TMS combined with a history of dying spell may be the major fatal complication.

Stoma prolapse is a common complication of intestinal stoma. Although various surgical methods yield satisfactory results, nonsurgical treatment may be better for a temporary stoma. We report a case of a patient with a distal limb prolapse of a right transverse colostomy who received nonsurgical treatment with satisfactory results. For the treatment of a temporary transverse loop colostomy with distal limb prolapse, we designed a simple device consisting of a pediatric plastic medicine cup, which was rolled into a towel to shape the bottom of the cup into a compressor. The towel was put on the stoma outside of the colostomy bag with the compressor above the prolapsing limb of the colostomy. An abdominal binder was applied to fix the towel.

Background/Introduction Although the surgery for hepatoblastoma (HB) is the mainstay of treatment, the surgical strategies for HB still need elucidation. Purpose This study evaluates the surgical results of HB in our institution since 1996, and we discuss surgical strategies targeting HB. Methods Retrospective chart review. Results We enrolled 14 patients, of whom 12 and two were newly diagnosed and tumor recurrence patients, respectively. Among the 12 newly diagnosed patients, hepatectomy was performed before and after chemotherapy in four and eight patients, respectively. Tumor resectability was strongly dependent on the surgeon's experience in three cases, achieving long-term tumor-free survival in these patients. One of eight patients with a definite resectable tumor had recurrent HB and received live donor liver transplantation (LDLT) immediately after recurrence, subsequently achieving long-term tumor-free survival. One patient with a definite resectable tumor died because of a congenital heart anomaly. Long-term tumor-free survival was achieved in 91.7% of the newly diagnosed patients. For the two patients referred for recurrence, LDLT was performed on one patient with recurrent HB, although recurrence was observed 4 months after the transplant, and the patient died because of cachexia 1 year after receiving LDLT. A liver autotransplant was performed on the other referred patient with HB recurrence, which failed because of abdominal compartment syndrome. Conclusion A careful complete resection of HB combined with aggressive chemotherapy can yield long-term survival in most patients with HB. Liver transplantation should be performed in patients with unresectable tumors and tumor recurrence immediately after recurrence. Repeat hepatectomy is not recommended if a live donor is available.

Four pediatric cases of chylothorax after cardiothoracic surgery, which were managed surgically, are reviewed retrospectively. All patients underwent right thoracotomy and mass ligation of the right thoracic duct without detecting the true site of leakage. Although 1 patient died from heart failure the day after operation, the other 3 recovered quickly without sequelae. Based on our limited experience, we suggest that right thoracotomy with mass ligation of the right thoracic duct can successfully cure chylothorax on either side, particularly if identification of the site of leakage is considered too risky because of severe adhesion from previous cardiothoracic surgery.

Methylmalonic acidemia (MMA) is a very rare genetic disease of metabolism that progressively leads to neurological and renal sequelae. This report describes an unusual case of a patient with MMA who developed severe hyperkalemia and severe dysrhythmia during anesthesia. A 13-month-old male infant with MMA underwent urgent insertion of a port-a-cath under general anesthesia. A life-threatening arrhythmia suddenly occurred, with severe hyperkalemia (up to 7.4 mmol/L), immediately following induction of anesthesia. Emergent resuscitation was successfully carried out, with a complete neurological recovery after 7 days after surgery. Although MMA is a rare complication, the possibility of severe hyperkalemia should be considered in the differential diagnosis of patients with MMA presenting with wide QRS complex tachycardia. The management and intraoperative complications of this disorder are reported here, and the available literature is reviewed.