Purpose: The purpose of this study was to determine the characteristics of patients with failed initial Kasai portoenterostomy (KP) and to compare the long-term prognosis of redo-KP with that of liver transplantation (LT) in these patients. Methods: The medical records of patients with biliary atresia (BA) who failed initial KP from 2010 to 2021 at a single center were retrospectively analyzed. KP failure was defined as persistent jaundice (total bilirubin concentration, ≥2.0 mg/dL) after KP or the performance of LT. Results: During the study period, 32 patients experienced initial KP failure, with 10 undergoing redo-KP and 22 undergoing LT. Redo-KP was successful in a minority of patients with failed initial KP, but the complications, particularly cholangitis, were more frequent in the redo-KP group. The long-term prognosis of redo-KP compared to LT showed that while some patients benefited from native liver survival after redo-KP, LT remains the more definitive solution for sustained liver function and survival in patients with BA. Conclusion The only factor differing significantly between patients who underwent redo-KP and LT after failed initial KP was complications of cholangitis. Redo-KP was successful in 4 of 10 patients with failed initial KP, suggesting that redo-KP may be a treatment option in patients with BA and failed initial KP.

Purpose: The purpose of this study was to determine the characteristics of patients with failed initial Kasai portoenterostomy (KP) and to compare the long-term prognosis of redo-KP with that of liver transplantation (LT) in these patients. Methods: The medical records of patients with biliary atresia (BA) who failed initial KP from 2010 to 2021 at a single center were retrospectively analyzed. KP failure was defined as persistent jaundice (total bilirubin concentration, ≥2.0 mg/dL) after KP or the performance of LT. Results: During the study period, 32 patients experienced initial KP failure, with 10 undergoing redo-KP and 22 undergoing LT. Redo-KP was successful in a minority of patients with failed initial KP, but the complications, particularly cholangitis, were more frequent in the redo-KP group. The long-term prognosis of redo-KP compared to LT showed that while some patients benefited from native liver survival after redo-KP, LT remains the more definitive solution for sustained liver function and survival in patients with BA. Conclusion The only factor differing significantly between patients who underwent redo-KP and LT after failed initial KP was complications of cholangitis. Redo-KP was successful in 4 of 10 patients with failed initial KP, suggesting that redo-KP may be a treatment option in patients with BA and failed initial KP.

Replacement of the retrohepatic inferior vena cava (IVC) after concurrent resection of IVC and tumor-bearing liver is regarded as a feasible living donor liver transplantation (LDLT) technique to cope with tumors around the IVC. This method can make the resection extent of LDLT comparable to that of deceased-donor liver transplantation. We present one pediatric LDLT case with IVC replacement using an enlarged iliac vein conduit to treat advanced hepatoblastoma. The patient was a 33-monthold and 12 kg-weighing girl suffering from large multiple hepatoblastomas invading the retrohepatic IVC. At 2-month waiting after deciding LDLT, we obtained a coldstored iliac vein graft and LDLT was performed with the father’s left lateral section graft. A 1.3 cm-wide and 10 cm-long iliac vein was transformed to be a 2 cm-wide and 5 cm-long vein graft through a double-barrel unification venoplasty. The left lateral section graft was implanted along the standard procedure of LDLT. The patient recovered uneventfully and is undergoing scheduled adjuvant chemotherapy. IVC replacement with vein homograft is a feasible option for LDLT in pediatric patients with advanced liver malignancy.

Purpose: The purpose of this study was to determine the characteristics of patients with failed initial Kasai portoenterostomy (KP) and to compare the long-term prognosis of redo-KP with that of liver transplantation (LT) in these patients. Methods: The medical records of patients with biliary atresia (BA) who failed initial KP from 2010 to 2021 at a single center were retrospectively analyzed. KP failure was defined as persistent jaundice (total bilirubin concentration, ≥2.0 mg/dL) after KP or the performance of LT. Results: During the study period, 32 patients experienced initial KP failure, with 10 undergoing redo-KP and 22 undergoing LT. Redo-KP was successful in a minority of patients with failed initial KP, but the complications, particularly cholangitis, were more frequent in the redo-KP group. The long-term prognosis of redo-KP compared to LT showed that while some patients benefited from native liver survival after redo-KP, LT remains the more definitive solution for sustained liver function and survival in patients with BA. Conclusion The only factor differing significantly between patients who underwent redo-KP and LT after failed initial KP was complications of cholangitis. Redo-KP was successful in 4 of 10 patients with failed initial KP, suggesting that redo-KP may be a treatment option in patients with BA and failed initial KP.

Purpose: This study aimed to identify factors influencing nursing professionalism among outpatient nurses. Methods: Data were collected through a self-evaluation survey of 157 nurses from general and tertiary hospitals in Seoul and Gyeonggi-do, Korea. Data were analyzed using independent t-tests, one-way ANOVA, Importance-Performance Analysis, Pearson correlation coefficients, and multiple regression analysis. Results: The mean scores were as follows: importance, 3.29 out of 5; performance, 2.50 out of 4; role conflict, 3.23 out of 5; and nursing professionalism, 3.23 out of 5. There were statistically significant positive correlations between the importance (r=.32, p<.001) and performance (r=.38, p<.001) of nursing activities and professionalism. There were statistically significant negative correlations between role conflict and nursing professionalism (r=-.20, p=.014). Stepwise multiple regression analysis showed that the importance of nursing activities, performance of nursing activities, role conflict, working department, and sex explained 33.0% of outpatient nurses’ professionalism (F=8.66, p<.001). Conclusion The findings indicate educational system about important and highly accomplished tasks would be useful to improve nursing professionalism of outpatient nurses. Furthermore, reducing role conflicts by clearly distinguishing tasks is necessary to increase nursing professionalism.

Purpose: This study aimed to identify factors influencing nursing professionalism among outpatient nurses. Methods: Data were collected through a self-evaluation survey of 157 nurses from general and tertiary hospitals in Seoul and Gyeonggi-do, Korea. Data were analyzed using independent t-tests, one-way ANOVA, Importance-Performance Analysis, Pearson correlation coefficients, and multiple regression analysis. Results: The mean scores were as follows: importance, 3.29 out of 5; performance, 2.50 out of 4; role conflict, 3.23 out of 5; and nursing professionalism, 3.23 out of 5. There were statistically significant positive correlations between the importance (r=.32, p<.001) and performance (r=.38, p<.001) of nursing activities and professionalism. There were statistically significant negative correlations between role conflict and nursing professionalism (r=-.20, p=.014). Stepwise multiple regression analysis showed that the importance of nursing activities, performance of nursing activities, role conflict, working department, and sex explained 33.0% of outpatient nurses’ professionalism (F=8.66, p<.001). Conclusion The findings indicate educational system about important and highly accomplished tasks would be useful to improve nursing professionalism of outpatient nurses. Furthermore, reducing role conflicts by clearly distinguishing tasks is necessary to increase nursing professionalism.

Purpose: This study aimed to identify factors influencing nursing professionalism among outpatient nurses. Methods: Data were collected through a self-evaluation survey of 157 nurses from general and tertiary hospitals in Seoul and Gyeonggi-do, Korea. Data were analyzed using independent t-tests, one-way ANOVA, Importance-Performance Analysis, Pearson correlation coefficients, and multiple regression analysis. Results: The mean scores were as follows: importance, 3.29 out of 5; performance, 2.50 out of 4; role conflict, 3.23 out of 5; and nursing professionalism, 3.23 out of 5. There were statistically significant positive correlations between the importance (r=.32, p<.001) and performance (r=.38, p<.001) of nursing activities and professionalism. There were statistically significant negative correlations between role conflict and nursing professionalism (r=-.20, p=.014). Stepwise multiple regression analysis showed that the importance of nursing activities, performance of nursing activities, role conflict, working department, and sex explained 33.0% of outpatient nurses’ professionalism (F=8.66, p<.001). Conclusion The findings indicate educational system about important and highly accomplished tasks would be useful to improve nursing professionalism of outpatient nurses. Furthermore, reducing role conflicts by clearly distinguishing tasks is necessary to increase nursing professionalism.

Purpose: This study aimed to identify factors influencing nursing professionalism among outpatient nurses. Methods: Data were collected through a self-evaluation survey of 157 nurses from general and tertiary hospitals in Seoul and Gyeonggi-do, Korea. Data were analyzed using independent t-tests, one-way ANOVA, Importance-Performance Analysis, Pearson correlation coefficients, and multiple regression analysis. Results: The mean scores were as follows: importance, 3.29 out of 5; performance, 2.50 out of 4; role conflict, 3.23 out of 5; and nursing professionalism, 3.23 out of 5. There were statistically significant positive correlations between the importance (r=.32, p<.001) and performance (r=.38, p<.001) of nursing activities and professionalism. There were statistically significant negative correlations between role conflict and nursing professionalism (r=-.20, p=.014). Stepwise multiple regression analysis showed that the importance of nursing activities, performance of nursing activities, role conflict, working department, and sex explained 33.0% of outpatient nurses’ professionalism (F=8.66, p<.001). Conclusion The findings indicate educational system about important and highly accomplished tasks would be useful to improve nursing professionalism of outpatient nurses. Furthermore, reducing role conflicts by clearly distinguishing tasks is necessary to increase nursing professionalism.

Since the first introduction of robotic surgery systems in Korea in 2005, there has been a gradual increase in the number of robotic surgeries performed. However, robotic liver resection is one of the most complex procedures, and its application, especially to children, is still limited. Therefore, in this study, we aim to present our experiences with 2 pediatric patients who underwent robotic liver resection in Asan Medical Center and discuss the safety and feasibility of robot-assisted hepatectomy in pediatrics.

Purpose: Complicated vascular anomalies, characterized by encasing vital organ or diffusely locating unresectable lesion, pose therapeutic challenges with limited response to conventional treatment such as surgical resection or sclerotherapy. Sirolimus, an mammalian target of rapamycin inhibitor, has shown promising therapeutic effects in patients with vascular anomalies by inhibiting vascular endothelial growth factor, as reported in several studies. Here, we analyzed the treatment outcomes of patients who received sirolimus for complicated vascular anomalies at our institution. Methods: Patients treated with sirolimus at the Department of Pediatric Surgery, Asan Medical Center from January 2018 to December 2021 were included. Sirolimus was administered twice daily at a dose of 0.8 mg per body surface area (BSA), with dose adjustments to achieve a target drug concentration of 8–12 ng/mL. Adverse drug effects and therapeutic responses were periodically assessed. Treatment efficacy was evaluated based on clinical findings pre- and post-sirolimus administration, absolute volume reduction of lesions through imaging tests (magnetic resonance imaging; MRI), and relative volume reduction adjusted to the patient's BSA. Results: There were 16 females (50.0%) and 16 males (50.0%), with a median follow-up period of 41 months after sirolimus administration. Vascular anomaly types included lymphatic malformations (41%), venous malformations (28%), lymphovenous malformations (19%), and others (12.5%). The most common adverse effect was oral ulcer (6 patients). MRI volumetry revealed volume decreases in 17 patients (53.1%) with 22 patients (71%) exhibited lesion decreases relative to BSA. Notably, 9 patients (28.1%) had markedly decreased volume reduction based on absolute volume, and 12 (38.7%) based on volume compared to BSA. Conclusion Over a 2-year follow-up, sirolimus was effective in treating patients with complicated vascular anomalies, when administered with cautious consideration of side effects. A multidisciplinary approach is needed for evaluating treatment outcomes in these patients, necessitating further long-term research on adverse effects.