325 cases, who were operated during 2 years (1961-1962) at the Setagaya National Hospital were investigated for ileocecalgia and constipation after appendectomy, and 41 cases accompanied with constipation after appendectomy were studied roentgenologically. Most of the patients suffering from constipation after appendectomy were young ladies and belonged to the Type II, transverse colon Styl roentgenologically. A great number of the cases who had habitual constipation used to be accompanied with ileocecalgia postoperatively, and were hard to be treated for.

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Statistical observations of the cases with intestinal invagination on which surgical intervention was done at the Department of Surgery of Nagoya National Hospital during the past seven years were made. Furthermore, experience in this condition in adults was presented in some details.
There were a total of 24 cases, of which 21 were below 15 years of age. Much greater incidence in man (71.4%) was noted. There were 16 cases (76.2% of the children) of babies younger than 18 months old.
Simple ileocecal invagination was found in all cases of children; none of local predisposing factors such as intestinal polyp, diverticulum and tumor were found.
The prognosis was favorable in 57.1% of the cases in which surgical intervention was under taken within 12 hours from the onset. In thoses treated later than 2 hours, it was unfavorable.
There were several operative procedures, one of which was chosen according to the situation encountered, that is, resection of intestine, simple reposition of invagination, or the reposition combined with ileocecopexis and optionally added appendectomy.
The Operative mortality in those below 15 years showed a high rate of 28.5%. In all of the adult cases, a certain predisposing local factor was present. In one case of ileocecal invagination, leiomyosarcoma appeared to be responsible.
In another case of the same lesion, it was ascribable to intestinal polyposis.
There was a case of invagination at the site of Braun's interjejunal anastomosis which was perfomed after a gastyic resection.

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We have investigated the results of our surgical operations, laying emphasis on the complications followed them, conducted for 237 patients who had undergone gastrectomy in our hospital in the last five years, and come to a conclusion. as follows. In this connection these 237 cases include 116 stomach and duodenal ulcers, 95 stomach carcinomas, 21 chronic gastritis, 5 benign tumors and the others.
1) In the stomach and duodenal ulcers, there are 59 cases of one half resection, 68 cases of two third resection, 6 cases of less than one half resection and 9 cases of more than two third resection, of stomach body. As the extent of the resected area was conducted in propotion to the acidity tested before the surgical operation, most cases were resected more than two third of stomach.
2) From the results of gastric juice analysis practiced before and after surgical operation and answers from patients who had been demanded to reply, we could recognize that the conditions of the patients have been improved, the hyperacidity before operation becoming even lower than normal and that the patients who have gained relief in subjective symptoms count fourteen out of twenty-nine cases, who had undergone one half resection and eleven out of twenty-two cases whose stomach had been cut off by two third. There seems to be little difference between significance of the methods of surgical procedure.
3) There are 24 persons who had serious complications (including 9 death) within two weeks after gastrectomy, that is 10% in the total number of operated cases, and the motality is 3.8%.
4) The complications include in adequate suture, hemorrhage, ileus and acute pulmonary collapse. The occurences in respective diseases are as follows:
5) Since we surmise that incases of gastric carcinoma all the inadequate suture is due to hypoproteinemia, it may be important to supply an abundunt quantity of protein preoperatively. The bleeding occurs, for the most part, from the united would margins, therefore, we abdomish ourselves that the elaborate stunching me sure must be taken in surgical operation. Since ileus which often follows gastrectomy for gastric, carcinoma is mainly attributable to the metastasis or carcinomatous peritonitis, these operations should primarily have been avoided.

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1) During the period from January 1, 1958 through August 31, 1963, 508 patients received gastrectomy in our hospital including 184 malignant neoplasms such as gastric carcinoma and sarcoma, and 322 benign diseases such as peptic ulcer, gastric polyp, gastritis and so forth.
2) Postgastrectomy complications occurred in 87 (17.1%) out of the total cases presented here, and these included heart failure, pneumonia, bronchitis, suture insufficiency, passage disturbance at the site of a hastomosis, opening of operative wound and others. The patients with malignant neoplasm developed the complications more frequently than those with benign disorder. Regardless of nature of the original diseases, the aged people were more frequently affected by the complications and showed more unfavorable prognosis for recovery from the complications.
3) Mortality rate after gastrectomy was 5.3 percent for the total of 508 cases while that was 26.4 percent for 87 cases with postgastrectomy complications. The aged people showed the mortality rate to be 57.1 per cent for 14 cases having complications.
4) Depennding upon the extent of stomach resected, the occurrence rate of the complications were varied, that is, it became higher and higher in the order of partial, subtotal and total gastrectomy. Seventeen out of 34 cases were succumed to the complications after total gastrectomy.
Gastrectomy combined with additional operations such as splenectomy, colectomy, cholecystectomy and others were followed by the complications more frequently than gastrectomy alone.
5) Of the preoperative complications, circulatory and hepatic disorders detected by ECG and liver function tests constituted the precipitating factors to increase the mortality rate after the post operative complications had developed.
6) The patients with abnormal findings in ECG taken before operation were more liable to contract the post operative complications involved in circulatory and respirotory organs than those without the findings. Eight out of 11 cases which had coronary insufficiency in ECG passed away after operation.
7) Eleven (2.1%) out of the total cases developed peritonitis secondary to suture insufficiency, 7 of which died of this complication. Passage disturbance at the site of an astomosis occurred in 8 cases (1.5% )which required further surgical intervention for the correction.

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389 cases of gastrectomy were performed during 5 years from April, 1958 through March, 1963. Among them, were cognized the complication suspected to be caused by surgical technic failure in 20 cases (5.14%).
The items of complication were as follows; early death within 7 days after operation (6 cases-1.54%), sutural insufficiency (4cases-1.03%), passage disturbance (5 cases-1.29%), hemorrhage into digestive tracts (2 cases-0.51%), acute pancreatitis (1 case-0.2%) and opening of operative wound at abdominal wall (2 cases-0.51%).
The operative method and technic of suture are discribed. Case reports of post-operative complication are presented and it's preveation is discussed.

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1) In past eight years, 305 cases of gastrectomy were performed for gastric cancer and peptic ulcer. There were five operative death (1.6 per cent) in 148 cases of gastric cancer, while there was no death in 175 cases of peptic ulcer.
2) The early post operative abdominal complications were 13 cases (4.2 per cent), which were shown in next Table.
3) Intestinal obstruction caused by adhesion occursoccasionally in the peptic ulcer with pyloric stenosis, for which we must take out large amounts of retained secretion and food from the stomach before surgery.
4) The paralytic ileus occurs often in the case of subtotal gastrectomy with extensive removal of lymphnodes, that evokes diminution of peristaltic movement, from which difficult to recover.
5) In the literature the incidence of anastomotic leaks after gastrectomy occurs frequently in the patient who has serum protein lesser than 6.0g%. Anastomotic leaks may happen in the case of hypoalbuminemia, however, even if serum protein is over than 6.0g% in our cases.
6) Necrosis of the remaining gastric wall would be caused by poor blood supply which evoked by bleeding from gastric section.
7) All death cases were found in the subtotal gastrectomy with extensive radical removal of regional lymphnodes.

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Statistical observation on 198 operated cases in past 2 years at Chiba National Hospital has been done in order to find out the prognosis of gastric-resection by examining preope-rative EKG and mortality rate as its index.
1) out of 198 cases, 28% showed abnormal EKG findings before surgery.
2) Out of all cases, the cases with normal EKG findings before surgery was 3.5% of mortality rate, while abnormal group was 13%, namely the mortality rate of the latter is higher than that of the former.
3) The more age advances, the more frequently abnormal EKG findings were observed. Group below the age of 40 was 14%, between the age of 41 to 60 was 27% and above 60 was 41%.
4) As to the benign and malignant diseases, the latter had higher mortality rate after surgery, and the cases with abnormal EKG findings before surgery showed high mortality rate in both groups.
5) The following groups who had abnormal EKG showed higher mortality rate after surgery comparing with the cases with normal EKG findings:
(1) The group below the age of 60 with myocardial damage.
(2) The group above the age of 61 with low voltage.
6) As to the mortal cases, all of 12 cases were cancer or perforation of stomach, and the cases with abnormal EKG findings before surgery were a little superior in number.
The author believe that the above-mentioned statistical observation made clear the relationship between preoperative electrocardiogram and results of the gastric-resection to some extent, although great at tention to the clinical findings and other examinations should be paid in order to make exactdecision of operative indication without depending only upon EKG findings.

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Forty-eight cases of total gastrectomy (cardial resection of the stomach, inclusive) with their operative results, long-term results and postoperative complaints are reported.
1) On the operative procedures, laparotomy with total gastrectomy and esophagojejunostomy were performed most frequently and the other various techniques; esophago-duodenostomy, esophago-gastrostomy under laparotomy-thoracotomy or thoracotomy only were dene.
2) Operative mortality rate was 6.2%; they are caused by wound dehiscence and pulmonary complications.
3) Postoperative long term results were: 3 years survival rate, 12%; 5 years, 10%.
4) Post operative complications were wound dehiscence, ileus, passage-disturbance of stomach and pulmomry complications, with incidense rate being 16%, and about half of them died.
5) Those who have severe dumping syndrome were not so many, while those with regurgitative esophagitis were one third of the total numbers.

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1) It was explained in detail in this report about our original method of anastomosing esophagus.
2) In short, it is an invagination of esophagus with jejunum or stomach Using Lubin's tube attached with rubber cork.
3) We believe it is aquite safe and reliable method, as we have never failed in bringing about a perfect unification of the anastomosed part; moreover it will enable to take food shortly after the operation, so preventing from losing physical strength.
About our gastrectomay:
4) Considering the physiological rotation of the stomach, we succeeded in preventing the anastomosed part from getting stricture in Billroth's first method.
5) About Billroth's second method, at first the whole layers of the stomach and of the jeiunum toward the greater curvature are approximated by a continuous suture, after then anterior and posterior sero-muscular layers were sutured by a interruppted way.
We are sure that cleanness of the anastomosed part could be kept in this method, and that it prevents the disturbance of the blood circulation, thus being able to diminish the possible edema.

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Among various types of postoperative complications following the gastrectomy, intragastric hemorrhage, gastric retention and/or obstruction, leakage from duodenal stump or gastrointestinal anastomosis, and injury of the proper hepatic artery due to surgery were discussed.
In view of the fact that the postoperative intragastric hemorrhage, not owing to sloughing. of the anastomotic suture line, can be prevented by the aid of suitable ligations of bleeding points at the suture line, amstomosis without clamp may be preferable to that with rubber-shod compression clamps on gastrointestinal canals, and when circumstances oblige the compression clamps to be applied, they should be loosend temporarily for the purpose of detecting and ligating the occult bleeding points at both the completed posterior suture line and the prepared anterior margin during the anastomotic procedure. And, when the de Petz clamp is applied, the divided stump should be fastend up by a contipuous overhand marginal inversion suture of all the coats including the single row of silver staples.
The gastric retention which occurs immediately following operation may be relieved by gastric lavage with continuous passive siphomge of gastric contents, color of which can indicate the gastrointestinal peristalsis and/or passage. The obstmction at the stoma, which seems to be caused frequently by the leakage of the suture line, can be demonstrated more diagnostically by fluoroscopic study than by the others. To keep the patency of a large stoma at the gastroduodenal anastomosis, the technique of the anastomotic sutures was modified, and favorable results have been obtained.
The leakage of the duodenal stump or of the anastomotic suture line has been known to becaused by over-tension due to influation, extension or torsion of the anastomosed areas, avascularization due to denudation of the prepared seromuscular coat, and technical in security of the procedure, and, moreover, it is postulated that the intramural hematoma at the anastomotic suture line is one of the most frequent causes of leakage. For the conservative treatment of postoperative leakage from a duodenal stump, wet dressings and/or tamponade of tenth normal hydrochloric acid or irrigation of it are successfully applicable.
If, during the course of a surgical operation, the proper hepatic artery is wounded and cannot be repaired exceptligation, the postoperative care should be concentrated upon both an enough strong antibiotic therapy and an antishock therapy.

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