J.Jpn. Surg. Soc.. 126(1): 46-50, 2025

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Feature topic

PEDIATRIC SURGICAL CARE IN AN AGE OF DECLINING BIRTHRATES: INSIGHTS FROM SMALL BOWEL TRANSPLANTATION

Japan has experienced a nearly 30％ decline in its birthrate over the past decade, which is expected to lead to fewer cases of pediatric intestinal failure (IF), particularly those requiring small bowel transplantation (SBT). IF primarily occurs in neonates and can progress to intestinal failure-associated liver disease (IFALD), necessitating SBT in severe cases. Recent advances in comprehensive intestinal rehabilitation, including the introduction of fish oil-based lipid emulsions (not yet approved in Japan), GLP-2 analogue treatments for short bowel syndrome, and improved catheter insertion techniques through interventional radiology, have enhanced the quality of care for pediatric IF patients. While these advances have reduced the need for SBT to some extent, liver–small bowel transplantation remains essential for patients with progressive IFALD. The number of SBT procedures in Japan remains limited to 3–5 per year, although donations from pediatric brain-dead donors have been increasing.
This paper discusses the current status of pediatric surgical care in the context of declining birthrates, focusing on the role of SBT and the challenges of organ donation. The approval of fish oil lipid emulsions and further increases in pediatric donors are expected to improve outcomes for pediatric IF patients and reduce mortality due to IFALD.

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