Purpose: Biliary atresia (BA) is a rare but progressive cholangiopathy and the leading cause of pediatric liver transplantation worldwide. The Korean Association of Pediatric Surgeons (KAPS) has conducted three national surveys (2001, 2011, and 2023) to assess long-term trends in the diagnosis, treatment, and outcomes of BA. This study provides a comparative analysis of the 2nd and 3rd national surveys, with reference to selected findings from the 1st survey. Methods: This study included 453 patients from the 3rd national survey (2011–2021) and 435 patients from the 2nd survey (2001–2010), all of whom underwent Kasai portoenterostomy. Data were collected via electronic case report forms from pediatric surgical centers nationwide. Comparisons were made regarding demographics, clinical features, diagnostic patterns, operative details, follow-up outcomes, and survival. Kaplan–Meier analysis was used to evaluate long-term survival. Results: The mean number of BA patients per year remained stable between surveys (43.5 in the 2nd, 41.18 in the 3rd), though centralization of care increased, with 61.5% of cases managed by two major institutions in the 3rd survey. The median age at surgery decreased, and the use of preoperative imaging (especially magnetic resonance cholangiopancreatography) increased. The 10-year native liver survival rate declined from 59.8% to 53.7%, while overall 10-year survival improved slightly (92.9% to 93.2%). Postoperative complications, such as cholangitis and liver failure, persisted but were better categorized. The 3rd survey also reported improved mortality (4.9%) and reduced follow-up loss (11.5%) compared to the 2nd survey. Conclusion While overall survival after Kasai operation has remained high and even improved, native liver survival has slightly declined. The findings reflect earlier diagnosis, more consistent diagnostic imaging, and increasing centralization of care. These trends underscore the importance of long-term nationwide data collection in guiding future strategies for BA management in Korea.

Purpose: This study aims to investigate and compare the incidence, demographic characteristics, clinical manifestations, preoperative diagnostic methods, anatomical classifications, associated anomalies, operative treatments, and postoperative outcomes of patients with intestinal atresia treated by the members of the Korean Association of Pediatric Surgeons (KAPS) through three nationwide surveys. Methods: KAPS conducted 3 national surveys in 1998, 2010, and 2024 to examine the patients diagnosed with intestinal atresia. In preparation for the survey, we developed a customized case registration form to obtain data on patient sex, birth weight, gestational age, clinical manifestations, preoperative diagnostic methods, anatomical types, associated anomalies, operative treatments, and postoperative outcomes. Authorized KAPS members completed the case registration form. Results: The first, second, and third national surveys included 218, 222, and 236 individuals diagnosed with intestinal atresia, respectively. The male-to-female ratios were 1.5:1, 1.1:1, and 1.1:1, respectively. The first, second, and third national surveys revealed that 34.3%, 43.3%, and 53.4% of patients were born before 37 weeks of gestation, respectively. Additionally, 28.7%, 32.0%, and 40.7% of patients had a birth weight under 2,500 g. In the third national survey, duodenoduodenostomy was the most common procedure, performed in 70 out of 82 patients diagnosed with duodenal atresia. Resection and anastomosis were the main surgical procedures conducted in 47 out of 54 cases of jejunal atresia and 74 out of 92 cases of ileal atresia. The mortality rates in the first, second, and third national surveys were 13.8%, 3.6%, and 1.3% respectively, with the lowest rate observed in the third national survey. Conclusion These national surveys offer valuable insights into the current state of intestinal atresia, including specific surgical interventions and postoperative outcomes in South Korea. For pediatric surgeons aiming to enhance their understanding of intestinal atresia and its treatment options, these surveys could be an indispensable resource and guide.

Objectives: To compare presurgical skeletal factors and postsurgical relapse patterns between more relapsed (MR) and less relapsed (LR) groups. Materials and Methods: This study retrospectively examined patients who underwent mandibular setback surgery, classifying them into two groups based on the amount of relapse of the pogonion using K-means analysis. Comparisons were conducted by analyzing cephalometric radiographs presurgically (T0), at 1-month post-surgery (T1), and immediately after orthodontic treatment (T2). Results: The MR group at T0 had a lower articular angle and AB to the mandibular plane angle (MPA), higher gonial angle, shorter anterior and posterior facial heights, and shorter Frankfort horizontal plane to the upper incisor and first molar. The articular angle in the MR group increased postoperatively. The Frankfort MPA (FMA) did not differ significantly between the MR and LR groups. Conclusion Acute articular angle and short facial height with a high gonial angle in the presurgical stage can predict surgical relapse regardless of the FMA.

Objectives: To compare presurgical skeletal factors and postsurgical relapse patterns between more relapsed (MR) and less relapsed (LR) groups. Materials and Methods: This study retrospectively examined patients who underwent mandibular setback surgery, classifying them into two groups based on the amount of relapse of the pogonion using K-means analysis. Comparisons were conducted by analyzing cephalometric radiographs presurgically (T0), at 1-month post-surgery (T1), and immediately after orthodontic treatment (T2). Results: The MR group at T0 had a lower articular angle and AB to the mandibular plane angle (MPA), higher gonial angle, shorter anterior and posterior facial heights, and shorter Frankfort horizontal plane to the upper incisor and first molar. The articular angle in the MR group increased postoperatively. The Frankfort MPA (FMA) did not differ significantly between the MR and LR groups. Conclusion Acute articular angle and short facial height with a high gonial angle in the presurgical stage can predict surgical relapse regardless of the FMA.

Objectives: To compare presurgical skeletal factors and postsurgical relapse patterns between more relapsed (MR) and less relapsed (LR) groups. Materials and Methods: This study retrospectively examined patients who underwent mandibular setback surgery, classifying them into two groups based on the amount of relapse of the pogonion using K-means analysis. Comparisons were conducted by analyzing cephalometric radiographs presurgically (T0), at 1-month post-surgery (T1), and immediately after orthodontic treatment (T2). Results: The MR group at T0 had a lower articular angle and AB to the mandibular plane angle (MPA), higher gonial angle, shorter anterior and posterior facial heights, and shorter Frankfort horizontal plane to the upper incisor and first molar. The articular angle in the MR group increased postoperatively. The Frankfort MPA (FMA) did not differ significantly between the MR and LR groups. Conclusion Acute articular angle and short facial height with a high gonial angle in the presurgical stage can predict surgical relapse regardless of the FMA.

Background: We evaluated the long-term effects of domiciliary noninvasive positive-pressure ventilation (NIPPV) used to treat patients with chronic obstructive pulmonary disease (COPD). Methods: Databases were searched to identify randomized controlled trials of COPD with NIPPV for longer than 1 year. Mortality rates were the primary outcome in this meta-analysis. The eight trials included in this study comprised data from 913 patients. Results: The mortality rates for the NIPPV and control groups were 29% (118/414) and 36% (151/419), suggesting a statistically significant difference (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65–0.95). Mortality rates were reduced with NIPPV in four trials that included stable COPD patients. There was no difference in admission, acute exacerbation and quality of life between the NIPPV and control groups. There was no significant difference in withdrawal rates between the two groups (RR, 0.99; 95% CI, 0.72–1.36; p=0.94). Conclusion Maintaining long-term nocturnal NIPPV for more than 1 year, especially in patients with stable COPD, decreased the mortality rate, without increasing the withdrawal rate compared with long-term oxygen treatment.

Background: Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea. Methods: A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma–COPD (ACO) and pure COPD was performed. Results: We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016). Conclusion Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.