薄井 佳子

PURPOSE: To evaluate the current status of neonatal surgery in Japan based on the National Clinical Database-Pediatric (NCD-P) registry, a survey conducted every 5 years by the Committee of the Japanese Society of Pediatric Surgeons. METHODS: We summarized and compared the survey data on neonatal surgical cases from 2018 to 2023 using the NCD-P registry to analyze current trends. RESULTS: The total numbers of summarized cases in 2018 and 2023 were 2,828 and 2,544, respectively, reflecting a 10.0% reduction. A decline was observed in maternal transport cases among patients with a prenatal diagnosis, while there was no significant difference in the mortality rate among these patients. Regarding the number of cases of neonatal surgical diseases, anorectal malformations and esophageal atresia ranked first and second in both surveys. The number of gastroschisis cases declined markedly in 2023. Chronological change in the overall mortality was not significantly different between 2018 and 2023. In 2023, 185 neonates (10.1%) underwent endoscopic surgery. CONCLUSIONS: The survey data show that the overall mortality rate of neonatal surgical cases did not change from 2018 to 2023. The decrease in neonatal surgical cases seems to be mainly due to a decline in the national birth rate.

INTRODUCTION: Cervical esophageal duplication is a rare congenital anomaly that occasionally causes compressive symptoms. Herein, we present a unique case of unilateral vocal cord paralysis caused by a cervical esophageal duplication cyst with a granuloma containing a foreign body. CASE PRESENTATION: A 10-year-old boy presented with a 1.5-month history of hoarseness and choking. Laryngoscopy revealed left vocal cord paralysis, and CT revealed a mass near the inferior pole of the left thyroid lobe. Fine-needle aspiration cytology revealed no evidence of malignancy. Ultrasonography and MRI findings suggested an esophageal duplication cyst with an inflammatory granuloma. Antibiotic therapy was ineffective, and a surgical approach was considered. The esophageal duplication cyst was resected through a collar incision, and a film-like foreign body with granulation tissue was extracted from the abscess. The recurrent laryngeal nerve was preserved, and the vocal cord function improved within 2 months. CONCLUSIONS: This case highlights the unusual presentation of an inflamed cervical esophageal duplication cyst with an embedded foreign body, which resulted in recurrent laryngeal nerve impairment and subsequent unilateral vocal cord paralysis. Early surgical intervention with careful nerve preservation can result in a functional recovery.