Postoperative (adjuvant) chemothrapy with 5-fluorouracil (5-FU) and cisplatin (CDDP) has been shown to prolong the survaival time in patients with advanced gastric cancer. A series of 32 patients with gastric cancer with paraaortic lymph nodes metastasis whose peritoneal dissemination was limited to P0 or P1 and hepatic metastasis to H0 or H1 were experienced in a recent 6-year period from January 1990 to December 1996. Of these 32 patients. 14 patients were assigned to the postoperative combination chemotherapy group and the remaining 18 patients were served as control, and two groups were compared for postoperative survival time. Five hundred mg/body/day of 5-FU was continuously administered via venus catheter for 5 days and 5 or 10mg/body/day of CDDP was rapidly administered with 100 ml saline on days 1_??_5. The survival period was prolonged in the 14 patients who underwent surgery plus continuous 5-FU and low dose (daily) CDDP compared with the control patients (p<0.05). The 50% survival duration of the combination therapy group was 19 months versus 9 months in the control group. Adverse side effects included leukopenia, thrombocytopenia, nausea, appetite loss and general fatigue; these were not life-threatening and did not requirer interruption of the therapy. Continuous 5-FU and low dose (dairy) CDDP therapy combined with extensive surgery provides an effective and practical method of treating this disease entity.

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Laparoscopic omental patch repair (LOPR) has been performed in six patients with perforated duodenal ulcer in a recent one decade between August 1987 and July 1997. In the present study, the six patients who underwent a LOPR (laparoscopy group) and another 24 patients who underwent omentopexy following a celiotomy (celiotomy group) were compared. The average time-lapse between the onset of the condition and operation was 22.3 hours for the laparoscopy group and 17.8 hours for the celiotomy group. A longer time elapsed in the laparoscopy group. Mean white blood cell counts at the time of admission were 13, 250/μl for the laparoscopy group and 11.943/μl for the celiotomy group, without significant difference. The average surgery time was 124 minutes for the laparoscopy group and 108 minutes for the celiotomy group. The average timelapse between surgery and the start of ingestion was six days for the laparoscopy group and seven days for the celiotomy group. The average length of hospital stay was 11 days for the laparoscopy group and 14 days for the celiotomy group. Patients who underwent an omentopexy following a celiotomy were hospitalized significantly longer. These findings suggest that LOPR is not only as effective as celiotomy omentopexy in treating perforated duodenal ulcers, but also provides some advantages such as less postoperative pain, smaller surgical wounds, and early recovery.

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In a period from December 1996 to June 1997 two-ports laparoscopic appendectomy with an abdominal wall-lift method was attempted in 50 patients and successfully completed in 47 patients. The remaining three patients were converted from laparoscopic to open operation. The cause of unsuccessful procedures was inflammation due to local peritonitis. Those 47 patients undergoing the laparoscopic appendectomy were compared with another 47 patients undergoing open appendectomy in the same period.
The mean operation time in laparoscopic procedures was not significantly longer than that in open surgeries (47.4×23.4 minutes versus 44.8×16.8 minutes). The hospital stay was significantly shorter (4.0×1.1 days versus 8.0×3.9 days). There were three cases of wound infection after open operation, but none after the laparoscopic operation. Laparoscopic appendectomy in able to differentiate the disease from gynecological lesions easily and exactly.
This procedure has many advantages such as shorter hospital stay, early return to normal activities and minimal wound complications including infection. It also offers a cosmetic advantage. Moreover, this procedure is able to make up the disadvantages of laparoscopic appendectomy with pneumoperitoneum.
Our experience has suggested that this procedure, that has not been reported so far, can be performed routinely in most patients with appendicitis.

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This study was designed to elucidate the significance of preoperative computed tomography during arterial portography (CTAP) in surgical treatment of hepatocellular carcinoma (HCC). Eighteen patients with HCC whose minute lesions had been pointed out by CTAP preoperatively (CTAP positive group) were compared with another eight patients with HCC having postoperative recurrence in a region at where no tumors had been detected by preoperative CTAP (CTAP negative group) for preoperative location of tumor and postoperative pattern of recurrence. In the CTAP positive group, 11 patients had recurrence and the remaining seven patients had not. Disease-free periods up to recurrences were 8.7 months in an average in the 11 CTAP positive patients and 16.6 months in the CTAP-negative group, showing a significantly shorter interval in the CTAP positive patients. In recurred cases from the CTAP positive group, tumors identified by imaging procedures other than CTAP were solitary in four and multiple in seven cases, while all solitary in nonrecurred cases. In the recurred CTAP positive cases, actual recurrence occurred in the same segment where a tummor had been pointed out by CTAP alone in five out of six cases of solitary recurrenc; or involved the same segment where CTAP detected tumor (s) in four out of five cases of multiple recurrence. It is indicated that the possibility of postoperative recurrence of HCC is high in cases having minute lesions visualized by CTAP alone in addition to multiple lesions visualized by imaging procedures other than CTAP. We think that periodical imaging methods including CTAP are required for HCC patients.

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The aim of this study was to evaluate the indications for laparoscopic cholecystectomy (LC) and laparoscopic choledocholithotomy (LCL) in patients with a past history of laparotomy (especially in the upper abdomen). Patients were divided into three groups [Group A: no abdominal operations, Group B: lower abdominal surgery, Group C: upper abdominal surgery]. No statistically significant differences were observed in a comparison of open ratio (%) [A: 3.2%. B: 3.0%. C: 4.2%], but there were significant differences in the comparisons of operation time (min) [A: 69.4±31.2. B: 64.6±24.8, C: 91.4±31.0] (p<0.001) and postoperative stay (day s) [A: 6.4±5.1, B: 6.9± 3.7, C: 9.4±5.6 (p<0.01 vs group A, p<0.05 vs group B). However, the clinical course of the patients with a past history of upper abdominal surgery was unaffected by the statistically significant differences in operation time and postoperative stay. Still more, there were no significant differences in relation with intraoperative complications in the three groups. The difficulty of the LC and LCL operations was mostly determined by the degree of inflammation of the cholecystitis. Therefore, patients with a history of upper abdominal surgery should not be excluded from the indications for LC and LCL. Thus, LC and LCL are extremely useful for patients with a history of laparotomy (especially in the upper abdomen).

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Since 1996, we have employed two 5-mm trocars and one 3-mm trocar (fine trocar) for laparoscopic inguinal hernia repair. In this study, a series of 49 patients with inguinal hernia operated on at the hospital were divided into two groups; 25 patients who were operated on using two 10-mm trocars and one 5-mm trocar (conventional group) and 24 patients using two 5-mm trocars and one 3-mm trocar (fine trocar group). These two groups were clinically compared. Operative time was 86.5 min. in the conventional group versus 99.0 min. in the fine trocar group, without significant difference. No intraoperative complications were associated in the both groups. However, postoperative analgesic (pentazocine) was used in 19 cases from the conventional group and in 4 cases from the fine group, with a significant difference (p<0.001). A significant difference was also noted in postoperative hospital stay between both groups; namely 5.6 days in the conventional group and 4.3 days in the other (p<0.01). Surgical scars were measured 18.4mm under the navel, 14.2mm in the right, and 11.3mm in the left in the conventional group, versus 10.3mm, 4.9mm, and 1.8mm, respectively in the fine group, with significant differences (p<0.001). It is thought that the fine trocar that offers minimal surgical invasion and cosmetic benefits may contribute to a further spread of laparoscopic inguinal hernia repair.

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This study to compared two methods of hernia repair, one using sutured repair and the other using Marlex mesh^® with regard to postoperative quality of life. We sent a questionnaire to patients who had undergone inguinal hernia operations, in our department from January 1993 to September 1995. Hospital stay and duration of postoperative symptoms were shorter, and as a results, social rehabiltiation was more rapid when using Marlex mesh^® than with sutured repair. We concluded that hernioplasty using Marlex mesh^® was superior to sutured hernia repair with regard to quality of life.

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A patient temporally presented Horner's syndrome after a video-assisted thoracoscopic wedge resection of the lung for left pneumothorax is experienced. The patient was admitted to the hospital because of left chest pain, and was operated on with the diagnosis of left spontaneous pneumothorax. At operation, freeing of adhesions and electrocoagulation were needed at the apical chest wall. Horner's syndrome occurred after the operation but improved gradually. Careful manipulation is needed for pleura parietalis near the sympathetic nervous system.

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An extremely rare case of gastric cancer metastasized to the bilateral breasts is reported.
A 46-year-old woman was admitted to the hospital because of a left breast tumor and back pain. There was a previous history of undergoing a gastrectomy for gastric cancer [ow (-), aw (+), P0, H0, n2, t2. mp, infγ, ly2, v0, stage IIIa, cure. B] on October 29, 1993, when the histopathologic type was poorly differentiated adenocarcinoma. The patient became having the back pain and left breast tumor since around May, 1996 and a bone scintigraphy revealed remarkable bone metastasis. In June, an 8.6×7.6cm elastic hard mass infiltrating into the skin and nipple in the entire left breast and left axillary lymph node metastases were palpated, when no tumor was present in the right breast. In October a 5.8×5.6cm tumor was also palpated in the right breast. Neither needle aspiration biopsy cytology nor incisional biopsy of the left breast could differentiate between signet ring cell carcinoma arisen from the breast and metastasis from the gastric cancer. So a left modi-fied radical mastectomy was performed. Histopathologic exploration of the resected material offered a suspicion of breast metastasis of the gastric cancer. In making the definite diagnosis, paradoxical concanavalin A staining, HIK 1083 staining and galactose-oxydase-Shiff reaction which revealed the same positive reactions as the gastric cancer tissue showed were useful. She died of lung metastasis and carcinomatous pleuritis 5 months after the mastectomy.

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We experienced a case of chronic renal failure with bronchial arterial aneurysm. A 53-year-old man was admitted to the hospital because of abnormal shadow on a chest X-ray film. A mass in the right lower lung became large and was enhanced heterogenously on chest CT and magnetic resonance imaging (MRI). A lower lobectomy of the right lung was carried out under a diagnosis of malignant tumor of the lung, but the lesion which seemed to be a tumor was bronchial arterial aneurysm. Histopathological examination revealed aneurysm with thrombus. Bronchial arterial aneurysm is rare, with only 41 reported cases in Japan so far. This is the first case of the disease associated with chronic renal failure.

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An 18-year-old man was admitted to the hospital because he had a high fever and a severe cough with hemoptysis. A chest X-ray examination demonstrated a fluid-filled cyst measuring 4×4cm in the middle field of the right lung. He was allergic to house dust, ticks, and several kinds of foods and plants. He had been suffering from chronic rhinorrhitis for a long time, but he did not have asthma. After administration of CLDM (1.2g/day) and CTM (2.0g/day) for eight days, the infection of the cyst subsided, but the cyst itself remained as it had been. A few weeks after he was discharged from our hospital, he had a second infection of the cyst. During the second hospitalization, a diagnosis of infected bronchogenic cyst was made and surgery was eventually indicated. A partial resection of the right lung, including the cyst, was performed under thoracoscopic control. As a result of the resection, an actual pathological diagnosis was made to be allergic bronchopulmonary mycosis (ABPM) with cryptococcus instead. Histology revealed bronchocentric granulomatosis with epitheloid granuloma and necrotic eosinophils. We had been unable to accurately diagnose the ABPM before surgery because the symptoms and findings obtained by diagnostic examinations had not fulfilled Rosenberg's criteria. However, the findings obtained by histological and immunological examinations of resected specimen were consistent with the Bosken's criteria of ABPM.

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A simultaneously resected cace of pulmonary metastasis of colonic cancer and a primary lung cancer is reported. A 68-year-old woman underwent a sigmoidectomy (D2) for a sigmoid colon cancer, which was a well-differentiated adenocarcinoma classified in Dukes' B stage histologically. Thirty-three months after the sigmoidectomy, she underwent right upper and middle lobectomies for two pulmonary coion lesions: The two lesions were histologically compatible with those of metastases from the colonic cancer. Fifteen months after the thoracotomy, she underwent left pulmonary wedge resctions for S₈ and S₁₀ lesions. The S₈ lesion was a well-differentiated adenocarcinoma, being compatible with metastasis from the colonic cancer. The S₁₀ lesion had characteristics of the primary adenocarcinoma of the lung: macroscopic pleural indentation and cuboidal cancer cells proliferating with replacing the alveolar structures.
No other reports other than ours have demonstrated cases of simultaneous resection of pulmonary metastasis of colonic cancer and primary lung cancer. With an increase in colorectal and lung cancers in the Japanese population, similar cases as ours seem to increase in number.

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We have experienced a case of sleeve pneumonectomy for a squamous cell cell cacinoma of the lung invading the carina and trunks intermedius. A 69 year-old man who was under treatment for diabetes, hypertention and coniosis at another hospital was admitted to our hospital because of exertional dyspnea. Chestroentgenogram showed atelectasis of the right upper lobe. Computed tomogram and magnetic resonance imaging revealed a lesion involved the near carina. Bronchoscopic examination visualized that the tumor arised in the right upper lobe bronchus and invaded both the right wall of the carina and trunks intermedius. No vascular involvement was present. To perform a complete excision of the affected portion of bronchus, a sleeve pneumonectomy was performed and carinal reconstruction was successfully carried out with a telescoping tracheo-bronchial anastomosis. The anastomosis was wrapped with pericardial fat tissue. Hlstopathologically, it was well differentiated squamous cell carcinoma of t₄n₀m₀ in stage IIIb. The postoperative course was uneventful, and a bronchoscopy revealed good a anastomotic healing without stenosis or granulation. The patient has been free from cancer as of 15 months after the operation.

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A case of traumatic right diaphragmatic hernia which was successfully diagnosed by magnetic resonance imaging (MRI) is reported.
A 71-year-old man was seen at the hospital because of upper abdominal pain and vomiting after he got a bruice on the right aterior thoracic region when he fell down. A simple x-ray film of the chest revealed a right diaphragmatic elevation and gaseous distention. A diagnosis of right diaphragmatic hernia was made. In order to diagnose the contents and size of an openning of the hernia, chest MRI was performed. It revealed a clear picture that a portion of the colon from the ascending to transverse colon prolapsed from the hernia opening 2cm in diameter into the thoracic cavity. Emergency laparotomy revealed that the ascending colon, a part of the transverse colon and greater omentum prolapsed into the right thoracic cavity from a tendinous region anterior to the diaphragm; the hernia opening being 3×2cm in size.
MRI that is excellent in determination of prolapsed organs and visualization of the cephalocaudal continuation and is noninvasive is a very useful method for diagnosis of diaphragmatic hernia.

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We experienced a case of traumatic diaphragmatic hernia presented with intestinal obstruction 9 days after a blunt thoraco-abdominal injury and multiple fracture of the lower extremities.
A 64-year-old man was transferred to the hospital in shock state because he was bruised all over at a traffic accident. Chest CT scan revealed right hemopneumothorax and left homothorax, and a drainage was performed. The patient also had multiple fracture of the lower extremities. Open reduction was carried out after his general condition was improved. From around 9 th hospital day, abdominal distension, nausea and vomiting were recognized. Thoraco-abdominal x-ray films on the next day visualized dilated small intestine and gaseous distention. Traumatic diaphragmatic hernia was suspected and an emergency operation was performed. Upon laparotomy, a hiatus was present in the left diaphragm posterolaterally and the greater omenturn and transverse colon incarcerated into the thoracic cavity which were reduced by maneuver method. In addition, necrosis of the ileum about 10 cm in length was found that was thought a probable cause of intestinal obstruction and an excision of the intestine was performed.
It is etiologically inferred that traumatic injury of the intestine necrosed with time to develop intestinal obstruction that caused an increase in abdominal pressure resulting in prolupse of intentine through the injured diaphragm; and eventually delayed diaphragmatic hernia occurred.

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Spontaneous rupture of the esophagus is a relatively rare entity. It is said that the disease follows a fatal course unless appropriate treatments in the early stage. We experienced three cases of the disease, of which two cases were surgically and one cases was conservatively treated. Of the two operated cases, primary closure was performed in one case and the suture site was covered with a pedicled omental flap in another case. Their postoperative courses were uneventful and the two patients were discharged. Conservative therapy without mediastinal and thoracic drainage was performed in the remaining patient, who was an 85-year-old man that was the oldest in the Japanese literature so far. He was discharged from the hospital in good general condition.
In a review of 78 cases, including our cases, reported in Japan from 1993 to 1997, a comparison of the primary closure group with the covering method group in cases operated on within 24 hours after the onset of the disease. the occurrence rate of the anastomotic breakdown was significantly lower in the latter group than that of the former. We think that in some cases diagnosed as the disease early, the covering method should be performed rather than primary closure.

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We experienced a case of esophageal-bronchial fistula in a hemodialysis patients with chronic renal falure who was saved by operation on a two-step approach. A 55-year-old woman on hemodialysis from 1990 was addmitted to the department for refractory esophageal-bronchial fistura on March 7, 1995. She had been treated conservatively under the diagnosis of esophageal rupture and mediastinitis after upper gastrointestinal fiberscopy. Although a huge cavity and a fistula to the left bronchiole (B⁶ and B¹⁰) were recognized, severe inflammation, malnutrition, low cardiac function and low respiratory function prohibited from aggressive surgery. Therefore, we first tried to improve her general condition by enteral diet assisted with parental nutrition and transfusion. At operation, a two-step approach was adopted. The first operation was performed on September 19, 1995, including esophagectomy, esophagostomy, gastrostomy and closure of the fistura by suture and bond. Sixty-three days lator, the second operation was performed including reconstruction with gastric tube through the retrosternal routs. Postoperative course was uneventful. She was discharged from the hospital 37 days after the second operation.

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An 81-year-old woman was admitted to the hospital because of a 4-month history of appetite loss. Radiologic and endoscopic examinations revealed an esophageal carcinoma with a giant gastric submucosal tumor. Distal esophagectomy and proxymal gastrectomy with esophagogastrostomy through the intra-thoracic route were performed. The resected gastric submucosal tumor was 8.0×7.8×4.8cm in size, and histologically moderately differentiated squamous cell carcinoma. It was thought that the gastric lesion was intramural metastasis of the esophageal carcinoma. Operative and histological findings revealed no lymph node metastasis. She was discharged and has been recurrence free for 2 years and 2 months after the surgery.
Esophageal carcinoma with intramural gastric metastasis is relatively rare in a frequency of 1.0_??_4.7%. It is often observed that some metastases are larger than primary esophageal tumors, and others show a rapid growth. Patients who have esophageal carcinoma should receive careful examination of the stomach, even though the esophageal carcinoma is in an early stage and there is no lymph node metastasis.

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We experienced a case of basaloid-squamous carcinoma of the esophagus. A 61-year-old man was admitted to the hospital for the purpose of operation for intrathoracic carcinoma which was diagnosed at another hospital. Esophagography revealed a region at ImEi, and endscopy demonstrated an evevated lesion 6.5cm in longer diameter on the anterior wall of the esophagus 35cm from the incisors. A basaloid-squamous carcinoma was diagnosed by a biopsy and a total thoracic esophagectomy was performed. The resected material showed a 6.5×2.0cm type 1 lesion with an uneven surface. The histopathological diagnosis was basaloid-squamous carcinoma of the esophagus, with a stage grouping of a 2 n 1 M 0 Pl 0, stage III. Postoperative recombinant chemotherapy with adriamycin and 5-fluorouracil was conducted. The patient is doing well as of seven months after the surgery. About 54 cases of this carcinoma have been reported in Japan. Basaloid-squamous carcinoma of the esophagus has been reported to have poor prognosis on the whole, but the patients with the disease in early stage (superficial cancer type) have been known to have less lymph node metastasis with consequent long-term survival. We think that improvement in prognosis can be expected by early detection and therapy.

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A 67-year-old man was referred to the department with a diagnosis of esophageal cancer. On admission, a decrease in platelet count, 6.2×10/m³ and a slight increase in PAIgG were noted. So the patient was diagnosed as having idopathic thrombocytopenic purpura (ITP) as well.
The patient underwent high-dose γ-globulin therapy (286mg/kg/day) for 5 consecutive days prior to surgery. After confirming an increase in platelet count from 6.2×10⁴ to 16.7×10⁴/mm³, the patient safely underwent a subtotal esophagectomy, regional lymph node dissection (R3) and splenectomy. Although anastomotic insufficiency occurred, the complication was cured without surgical procedure.
We believe that the high-dose γ-globulin therapy that is able to increase platelets in a short time and has minimal adverse effects is very useful in preoperative management of the patients with esophageal cancer with ITP.

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Primary malignant melanoma of the esophagus is a rare disease, accounting for 0.1_??_0.4% of all esophageal neoplasms. Metastases are common to the liver, mediastinum, mediastinal glands and lung. We present a case of the disease with metastases to the skin, colon and mammary gland. There have been no reported cases of colon and mamma metastasis, and skin is also a rare site for metastasis. A 78-year-old woman was reffered to our hospital for weight loss and dysphagia. She had multiple subcutaneous tumors and a solitary mammary tumor. Esophagoscopy revealed a large polypoid tumor with foci of black pigmentation in the lower esophagus. Colonoscopy disclosed a small submucosal tumor. Biopsies from these tumors were all positive for HMB-45 staining, confirming the diagnosis of malignant melanoma. Junctional activity was not found in the tissue of the esophageal tumor, but its size, characteristic polypoid figure, melanosis of the adjacent mucosa and the absence of other possible primary lesions strongly suggested the esophagus origin.

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A rare case of adenomyoma of the stomach is presented together with its ultrasonographic findings by an endoscope. A 27-year-old-woman was referred to the hospital because of epigastric pain. An umbilicated submucosal tumor, 2cm in diameter, of the prepyloric region was disclosed by an endoscopy. Endoscopic ultrasonography (EUS) showed an irregular-shaped low-echoic lesion with hetero-echogenic inner part mainly in the fourth layer of the stomach. The patient underwent a partial resection of the stomach including the lesion and the diagnosis of adenomyoma was made by a frozen section during operation. The tumor 4.0×3.8cm in side. was composed of cysts and grandular structures lined by cuboidal-to-columnar epithelium surrounded by hypertrophic smooth muscle bundles. Furthermore, glands resembling pancreatic acinic cells were present. As of one year and 5 months after the surgery, she is doing well without paticular subjective symptoms. The usefulness of EUS in this case would be emphasized. The endoscopic and ultrasonographic characteristics of the lesion are discussed as well as diagnostic and therapeutic approaches.

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An 80-year-old woman who was admitted to the hospital for anemia was found to have multicentric mucosal lesions (5 lesions) of the stomach on an upper gastrointestinal series. Biopsies for all five lesions resulted in Group V. Pylorogastrectomy with D1+α lymphnodes dissection was performed.
Pathological evaluation after the operation revealed, one advanced Borrmann type 2 carcinoma and five other early carcinomas. Then we diagnosed them as synchronous multiple gastric carcinoma with six lesions.
With the aging of the Japanese population, multiple gastric carcinomas have been increasingly reported recently, but synchronous gastric carcinoma in six lesions like in this case is very rare.

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A 64-year-old woman was admitted to the hospital because of repeated severe anemia of unknown origin for about 4 years. Upper gastrointestinal (GI) series. endoscopy, barium enema study, and lower GI endoscopy revealed no origin other than gastric ulcer and we could not make any diagnosis. In order to explor the bleeding site, 99 mTc-RBC hemorrhagic scintigraphy was performed and a tumor or the small intestine was suspected. Fluoroscopic examination of the small intestine, abdominal CT scan, and angiography of the superior mesenteric artery comfirmed a jejunal tumor. Endoscopic biopsy offered a diagnosis of leiomyoma of the jejunum. It was a 50×45mm well-demarcated tumor about 15cm distal from the Treitz' ligament. A partial resection of the small intestine was carried out and it was diagnosed as gastrointestinal stromal tumor (GIST) histologically. Thereafter no recurrence of anemia nor metastasis of the tumor has occurred.
It is thought that hemorrhagic scintigraphy is a useful method for unexplained exacerbations of anemia.

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A case of cecal malignant villous tumor associating with an appendical mucinous cystadenocarcinoma is reported. A 59-year-old woman was incidentally found to have a cystic ileocecal lesion by abdominal CT scan for the purpose of follow-up for a femoral head's replacement surgery at the department of orthopedics. The patient was transferred to the department with a diagnosis of cystic ileocecal tumor. A laparotomy disclosed an elastic soft tumor, 6×7cm in size in the ileocecal junction and the cystically swollen appendix vermiformis. A right hemicolectomy was performed. The resected material revealed a whole-circumferential villous tumor measuring 4.5×6cm in the cecum and a mucinous cystic tumor in the appendix vermiformis. Histopathologically, the cecal tumor was diagnosed as villous adenoma coexisting with the well differentiated adenocarcinoma, and the appendical tumor was diagnosed as mucinous cystadenocarcinoma, which were double cancer existing independently.

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A 67-year-old woman suffering from constipation by nature was referred to the hospital in September 1998 because of repeated left lower abdominal pain, abdominal distention, and stools with slime and bloodstreaking for about 4 months. When she was first seen, abdominal simple x-ray film revealed a picture like a bunch of grapes. Barium enema study revealed a great number of oval-shaped, elevated and pneumatic lesions in the sigma elongation. A diagnoisis of pneumatosis cystoides intestinalis was made. On the other hand, a colonoscopic fiber revealed a narrowing in a part of the sigmoid colon. We thought that the narrowing irreversibly changed and performed a laparotomy-aided sigmoidectomy.
Pneumatosis cystoides intestinalis is a relatively rare entity that forms multiple peumatic cysts in the intestines. especially submucous or subserosal layer. There have been 509 cases of the disease in the Japanese literature as far as we could review, but mechanisms of the origin are still obscure. It is believed that hyper concentration oxygen therapy is most effective for the disease, but surgical therapy would be necessary for cases with some irreversible changes including narrowing of the intestine like this case.

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An interesting case of familial adenomatous polyposis (FAP) associated with small advanced cancer of the colon with lymph node involvement is reported. A 39-year-old man with FAP was admitted to the hospital because of advanced cancer of the sigmoid colon and early cancer of the lower part of recutum. Colonic stenosis due to the sigmoid lesion disturbed to detect any malignant lesions located orally from the sigmoid before surgery. At laparotomy, advanced sigmoid colon cancer with regional lymph node metastasis was found along with enlargement of epicolic lymph nodes of the ascending colon, although no mass lesion was palpable in the ascending colon. Restorative proctocolectomy with ileoanal canal anastomosis was performed, with levels of lymph node dissection D₂ for the rigtt-sided colon and D₃ for the sigmoid colon. Macroscopic appearance of the resected specimen showed a tumor of plat with depression type measuring 16mm in diameter in the ascending colon, together with a type 2 cancer of the sigmoid colon. Histological examination revealed that tumor of the ascending colon was a moderately differentiated adenocarcinoma invading the muscularis propria with lymph node metastasis. FAP patients presenting with large-bowel stenosis due to cancer may have occult small lesions with lymph node metastasis like this case. Surgeons should consider this possibility when curative colorectal resection is performed for FAP patients.

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A 66-year-old woman was admitted to the hospital because of abdominal pain and anemia. There were previous histories of bladder tumor, hysteromyoma, cerebellar angioblastoma, hypertention, and gastric ulcer. Her family history disclosed that heryounger sister had sufferd from Japanese Schistosomiasis. Since intestinal obstruction was detected during close examination for anemia, an emagency surgery was performed. During surgery, a tumor was detected in the sigmoid colon. Sigmoidectomy with lymph node dissection was performed. Pathological findings demonstrated that this tumor was a moderately differentiated ss n 2 P 0 H 0 M (-) stage IIIb adenocarcinoma. Furthermore, innumerable eggs of Schistosoma Japonicum were revealed centering around the submucosal layer of the resected colic tissue, which were presented even in subserosal tissue of the tumor as well as in the resected lymph nodes. We discussed the correlation between interposing eggs of Schistosoma Japonicum and the development of colon cancer.

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We have experienced a case of rectovesicofistula after a glycerin enema performed as a preparation of colonofiberscopy for polypectomy.
A 73-year-old man had a glycerin enema as a preparation of colonofiberscopy for polyps found by barium enema in some other hospital. He had a severe perianal pain diverging to his penis right after the enema. In spite of the injury to the rectal wall, he had a clipping closure under colonoscopy. Two weeks later, he was admitted to our hospital because of fecalurea, urine-mixed stool and pyrexia (39 centigrade). Colonoscopy and cystoscopy revealed a rectovesicofistula. Gastrographin enema and computed tomography revealed a perirectal abscess. We repaired the rectum and urinary bladder, built a diverting loop colostomy on the sigmoid colon, and drainaged the perirectal abscess operatively. The repaired sites were under good control after the operation.
Glycerin enemas are daily in usage in clinical scenes, and their rectal penetrations are rare complications. They sometimes develop some severe complications if adequate therapy in lacked. Perirectal abscesses should be drainaged as soon as possible after rectal injuries to avoid rectovesicofistulas.

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A patient with Fournier's gangrene associated with advanced rectal cancer who could not be saved because of rapidly deteriorated course is reported. A 75-year-old man complaining of tarry stool revealed apple core sign in the rectum Rb on a barium enema study, and was admitted to the hospital with a diagnosis of rectal cancer. At a digital examination of the rectum, a whole-circumference tumor was palpated. No perianal abnormalities were noted, but swellings in the same region and scrotum were confirmed and incision drainage was performed. Two days later a swelling with crackling sensation covering from the perineum to right lateral abdominal region continuously appeared. Emergency operation was performed where an incision drainage and a removal of necrosed tissues were performed. The patient was associated with postoperative disseminated intravascular coagulation (DIC) and consequent adult respiratory distress syndrome (ARDS), and was managed by artificial respiration. But the patient's condition deteriorated and died on the 6th postoperative day.
There have been only one domestic case and two foreign cases in which Fournier's gangrene was associated with rectal cancer before operation as far as we could review. In all cases, rectal cancers perforated the rectal wall and this direct invasion of cancer caused perianal abscess.

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Intratumor injection of OK-432 (total of 60KE) with low dose 5-FU/CDDP chemotherapy was given to a 56-year-old woman with second recurrent rectal carcinoma in the pelvis. By this treatment. the tumor decreased markedly in size, and tumor marker mapidly decreased and returned to a normal value. The marked respose corresponded well to a decrease in CD 8. It is likely that not only did the intratumor injection of OK-432 have direct cytotoxic action on malignant cells per se, but also enhanced the positive immunological response of the host.

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GRF glue^® is a newly developed glue, which can be used for a longer period effectively and efficiently for covering wound. As it is a non-human serum derivative product, there is no chance of transmission of blood born diseases such as AIDS and Creutzfeldt-Jakob disease. Since January 1996 when an additional indication of the glue for reinforcement of hemostasis at hepatectomy was approved, its usage in the abdominal surgeries has been incresingly facilitated. This case involved a 75-year-old woman who underwent an extended left lobectomy for a hepatohilar bile duct cancer, The operation and early postoperative course were uneventful. On the 7th postoperative day, fresh blood appeared from a drain placed in the resected wound of the liver. An emergency operation was arranged to stop the bleeding. At laparotomy, a ruptured ulcerative pseudoaneurysm of the common hepatic artey (CHA) was seen. The aneurysm was caused by the friction of Duple drain placed over CHA to the edge of the remnant liver and ruptured. After surgical repair of the aneurysm, it was reinforced with GRF glue^®. GRF glue^® effecttively prevented the re-rupture.

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We present a case of cancer of the sigmoid colon, in which a left caudate lobectomy for a metastasis to the left caudate was performed 4 years after a right hepatic lobectomy with right caudate lobectomy for a metastasis to the right caudate lobe 6 years after an operation for the primary colonic cancer.
A 58-year-old woman underwent a sigmoidectomy for a carcinoma of the sigmoid colon in 1986. Two years after the operation, a right lobus inferior pulmonis metastasis was noticed and a right lobus inferior pulmonis resection was performed. During observation on an ambulant basis, in 1991, about five years after the first operation, the high level in CEA was confirmed, and CT and US examinations demonstrated a metastasis in the right caudate lobe. Right hepatic lobectomy+light caudate lobectomy was performed under a diagnosis of independent metastasis from the sigmoid colon carcinoma. After that, CEA decreased to normal range, but in 1994, about eight months after the first operation. CEA level increased again to 93.5 and CT and MRI revealed an independent metastasis in left caudate lobe, so a left caudate lebectomy was performed. There have been no signs of recurrence.

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A case of small cystadenocarcinoma of the liver is reported. A 34-year-old woman complaining of suddenonset upper abdominal pain was admitted to the hospital because abdominal ultrasonography (US) revealed a liver cyst 2×2.5cm in size with a papillary projection 0.8cm in diameter in its lumen in the medial segment (S₄). The tumor was slightly enhanced on dynamic computed tomography in early phase. Though the lesion was small, cystadenocarcinoma of the liver was strongly suspected, and a partial excision (S₄) was performed. Intraoperative US also revealed the tumor in the cyst without invasion and lymph node metastasis. The final pathological diagnosis was cystadenocarcinoma of the liver arising from cystadenoma. The tumor existed only in the cyst and no liver invasion was found. The patients is doing well 52 month after the operation without any signs of recurrence and metastasis. This is the smallest liver cystadenocarcinoma arising from cystadenoma among those have been operated on. Recent progress in imaging studies has facilitated the discovery of such small liver tumors including cysts. Even if a small nodule in a cystic liver lesion is found, we must bear possibility of cancer growing in mind.

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Solitary tuberculoma of the liver is uncommon and this paper presents a hepatocellular carcinoma (HCC) case which occurred after the operation and antituberculous therapy for solitary tuberculoma of the liver. A 65-year-old man was admitted because of right hypochondralgia. Abdominal contrast computed tomography (CT) showed a mildy enhanced mass in the anterior inferior segment of the liver (S 5). Partial hepatectomy was performed with a suspected diagnosis of hepatoma. Pathohistologically the resected specimen was compatible with tuberculoma containing caseous necrosis and Langhans' giant cells. Antituberculosis drugs were prescribed for one year. Eighteen months after the operation, the enhanced tumor growing segmentally in the right posterior segment of the liver (S 7) was detected by the contrast CT scan. Angiography showed a hypervascularity in this tumor. These findings suggested HCC rather than a recurrence of the solitary tuberculoma, S 7 subsegmentectomy was performed. Microscopic examination revealed a travecular type HCC. A histogenetic relationship between tuberculosis of the liver and HCC was unknow. Abdominal contrast CT and angiography were useful for the definitive diagnosis. However, it is considered that a percutaneous liver needle biopsy should be tried for differential diagnosis of other hepatic tumors.

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We encountered three resected cases of hepatocellular carcinoma associated with Schistosomiasis japonica (SSJ). Patient 1 was a 67-year-old man who was born in Kurume-city, Fukuoka Prefecture. The patient was diagnosed as having liver cirrhosis (HBV +) and a primary hepatocellular carcinoma of the S8 segment, and underwent on excision of the anterior region of the liver. Patient 2 was a 51-year-old man who was born in Kurume-city, Fukuoka Prefecture. The patient was diagnosed as having liver cirrhosis (HBV +) and a primary hepatocellular carcinoma of the S6 segment, and a S6 partial resection was performed. Patient 3 was a 57-year-old man who was born in Isawa-city, Yamanashi Prefecture. The patient was diagnosed as having liver cirrhosis (HCV +), SSJ and a hepatocellular carcinoma of the primary lesion in the S8 of liver. and a S8 subsegmentectomy was performed. Microscopically, the patients 1 and 2 were diagnosed as having moderately differentiated hepatocellular carcinoma associated with SSJ, and the patient 3 was diagnosed as having highly differentiated hepatocellular carcinoma associated with SSJ. The patients 1 and 2 were infected with HBV, and the patient 3 was infected with HCV. There has been no reported incidence of SSJ in Japan since 1979, and its eradication was announced in February 1996. Liver cirrhosis and hepatocellular carcinoma have been occasionally found in the carriers of Schistosoma japonicum eggs, indicating that the diseases associated with SSJ are important.
When investigating the relationship between SSJ and hepatocellular carcinoma, the possible involvement of hepatitis viruses should be considered.

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Although metastatic seeding to the percutaneous transhepatic biliary (PTBD) sinus tract is a probable mode of metastasis after curative resection of biliary cancer, there have been few cases of the disease which was successfully resected. We present a case of curative resection for this type recurrencewith a review of the literature in Japan. A 75-year-old man with a distal bile duct carcinoma underwent a pylorus preserving pancreatoduodenectomy 40 days after PTBD for obstructive jaundice. Macroscopically, it was a nodular tumor at the distal bile duct. Microscopically, the tumor was moderately differentiated tubular adenocarcinoma invading subserosal layer and without nodal invasion. Seven months after the surgery, abdominal CT and US revealed a low density mass in the abdominal wall and the liver surface just blow the PTBD scar with a slight elevation of serum CA 19-9 level. This mass was diagnosed as a metastatic seeding at the PTBD sinus tract. A resection of the abdominal wall and a left lateral superior subsegmentectomy of the liver were performed. Re-sected specimen demonstrated a metastatic adenocarcinoma invading the abdominal muscle and liver. As of 6 months after the second surgery, the patient is in good health without any evidence of tumor recurrence. Caution should be paid for metastatic seeding at the PTBD sinus tract after surgery for biliary cancer.

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Adenosquamous cell carcinoma that of is a relatively rare histological type of the gallbladder neoplasms is reported.
A 60-year-old woman visited another hospital because of epigastralgia, and was found to have a gallbladder mass with gallstone by ultrasonography, computed tomography and endoscopic retrograde cholangiography. The patient was seferred to the hospital with a suspicion of carcinoma of the gallbladder. On admission, there were a 4.0×2.5cm papillary lesion in the neck and a 2.0×1.5cm solid protuberant lesion in the body of gallbladder. Cholecystectomy, choledochotomy and partial resection of the liver (S1, S4a, S5) were performed, with reconstruction of choledochojejunostomy by Roux-en Y method. Histologically, The papillary lesion was well differetiated adenocarcinoma and the protuberant lesion well differentiated squamous cell carcinoma. The squamous metaplasia revealed basal portion of adenocarcinoma, and the invasion of the squamous cell carcinoma was deeper than that of the adenocarcinoma.
It was etiologically suggested that adenosquamous cell carcinoma might be caused by squamous metaplasia of adenocarcinoma in the gallbladder.

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We report a case of pancreaticobiliary malfunction combined with pancreatic and biliary caliculi 28 years after choledochocysto-jejunostomy, in which both caliculi were radically operated on. A 33-year-old woman was admitted to the hospital because of upper abdominal pain. There were a previous history of undergoing a choledochyocst-jejunostomy for congenital dilatation of common bile duct at the age of five, and the patient had been complaining of an abdominal pain since the age of 24 which was alleviated by medication. After adomission she was diagnosed as having acute pancreatitis and a pancreaticobiliary maljunction with pancreatic and intrahepatic biliary caliculi based on abdominal CT, MRI, and ERCP. The patient was operated on. Operative procedured included a resection of the residual choledochal cyst, followd by Roux-en Y hepaticoje-junostomy and lateral segmentectomy of the liver for hepatolithiasis. Subsequently, pancreatolithotomy with a transduodenal papilloplasty was carried out for pancreatic caliculi. Postoperative histological findings revealed no malignancy in the gallbladder, liver and choledochus. Postoperative course was uneventful and the patient was discharged from the hospital. There have been no signs of recurrence of recurrence of caliculi. It is rare case that both pancreatic and biliary caliculi were simultaneously found after choledochocyst-jejunostomy. Some bibliographical notes are also presented here.

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A 46-year-old woman came to our hospital because of a feeling of abdominal fullness. An echograrn revealed a rough, mixed pattern tumor 3.5 cm in diameter in the pancreatic body. Abdominal CT showed a heterogeneously enhanced low-density tumor. Dynamic CT showed that the tumor was enhanced poorly in the early phase. A doppler echogram revealed the absence of any blood flow signal in the tumor. MRI visualized the tumor as a low-intensity mass on T 1-weighted images, and a high intensity mass on T 2-weighted images. ERP showed a normal main pancreatic duct, and the tumor filled with contrast medium. Serum levels of pancreatic enzymes (amylase, lipase, etc.), tumor markers (CEA, CA 19-9, etc.), and pancreatic hormones (insulin, glucagon, etc.) were normal. At laparotomy, the tumor was located in the pancreatic body, and was welldefined, smooth-surfaced, covered with a greyish white capsule, oval in shape, and elastic-soft on palpation. Distal pancreatectomy with splenectomy was performed. Histopathologically, the diagnosis was cavernous hemangioma arising in the pancreas.

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A case of minute malignant glucagonoma of the pancreas detected by a preparation after an operation for a cancer of the lower bile duct is reported.
A 72-year-old man was seen at the hospital because of fever.
Ultrasonography and CT revealed a swelling of the gallbladder and dilatation of the common bile duct and intrahepatic bile duct. A diagnosis of obstructive jaundice was made. With further percutaneous transhepatic cholangiodrainage (PTCD) and endoscopic study of the bile duct, a diagnosis of cancer of the lower bile duct was made and a pancreatoduodenectomy was performed. After the operation, a poorly demarcated and nodular tumorous lesion 1.5mm in size was demonstrated in the normal pancreatic tissues near the lower bile duct carcinoma on a histological study.
Immunohistologically, the tumor cells were positive only for glucagon, and hence the definite diagnosis of malignant glucagonoma of the pancreas was established.
Glucagonomas are rare and almost all tumors are more than 5cm in diameter. Such minute glucagonoma as the diameter is less than 5mm like in this case are extremely rare, and this case is the fourth in Japan. In addition, no other cases, which are associated with lower bile duct cancer, have been seen as far as we could review.

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A 49-year-old woman under dietary therapy for diabetes mellitus on an ambulant basis was pointed out to have a tumor of the pancreatic head by abdominal ultrasonography. She was admitted to the hospital for operation. There was a previous history of acute pancreatitis due to cholelithiasis 18 years before admission. Intraoperative frozen section histology offerred a suspicion of malignant carcinoid tumor. Pancreatic duodenectomy and cholecystectomy were performed. Conventional histopathological and immunohistochemical examinations revealed malignant solid cystic tumor of the pancreas. After the operation the patient recovered uneventfully. Solid cystic tumor of the pancreas is a rare type of pancreatic tumor and is common in young women. It is usually benign, but sometimes malignant with local recurrence and distant metastasis. We report our case together with a review of the literature.

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We experienced a case of solitary splenic metastasis after hepatectomy for hepatocelluler carcinoma. The case was a 69-years-old female without liver cirrhosis or hepatitis. She underwent “so called Right Liver Trisegmentectomy” for large hepatic tumor on November 16, 1993. Pathological findings revealed trabecular type moderately differentiated hepatocellular carcinoma. fc (+), fc-inf (+), Vp0, Vv0, b0, tw (-), im 1. Seven months later, we observed multiple liver metastasis and a low density splenic tumor of 2cm diameter by computed tomography. We perfomed Trans arterial embolization on the liver metastasis, but the splenic tumor had enlaged to 4cm diameter. We diagnosed the splenic tumor as metastasis of hepatocellular carcinoma. She underwent splenectomy on March 20, 1995. Before and during the operation, we found other evidence of metastatic tumors except for those detected in the liver and spleen. Immunological competence levels were within the normal range. There had been 8 cases of solitary splenic metastasis of hepatocellular carcinoma reported in Japan, and only 2 were resected.

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A 47-year-old woman was admitted to the hospital because of constipation at menses. Barium enema study and a colonoscopy revealed a whole-circumference stenosis in the rectum covered with normal mucosa. CT and magnetic resonance imaging (MRI) revealed a restiform structure between the uterus and rectum, and also revealed a right ovarian cyst.
In the light of these findings, we diagnosed the case as rectal endometriosis. In spite of the hormone therapy for a year. no remission in constipation at menses was attained. What is worse, side effect of the hormone therapy occurred. Therefore, a partial rectal resection and a total hysterectomy were performed. The operative findings showed a firm adhesion between the uterus and rectum and a chocolate cyst at the right ovarium. Histopathologically, endometrial cells with fibrotic change were seen in the submucosal layer of the rectum.
Endometriosis is characterized by ectopic proliferation of endometrial cells. Intestinal endometriosis is relatively rare disease and only 84 cases have been reported in the Japanese literature up to now. It is often difficult to make definite diagnosis preoperatively and careful attitude is essential to indicate operation and to select therapeutic tactics.

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Leiomyomas of the mesentery are very rare, and only 11 cases including this case have been seen in the Japanese literature.
A 71-year-old man was seen at the hospital because of the abdominal fullness and constipation. An infant head-sized mass which was elastic soft and smooth on its surface was palpated on the right lower abdomen with a remarkable mobility. Preoperative examination revealed a well-defined tumor with slightly heterogenous internal image in the mesentery. He was diagnosed as to have a mesenteric tumor and an operation was performed. The tumor was located in the mesentery of the small intestine, covering from 1.8 m to 3 m oral side from the Bauhin's valve and compressed the small intestine extramurally at two portions. No infiltration into the small intestine nor metastasis of mesenteric lymph nodes was found and a resection of the small intestine including the tumor was performed. The resected material was histologically diagnosed as leiomyoma.

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We experienced a case of lupus peritonitis which presented difficulty in differential diagnosis from strangulated ileus.
A 34-year-old woman was seen at the hospital because of abdominal pain lasting for 2 days. There were previous hitories of undergoing an appendectomy and being diagnosed as SLE, for that she had been treated as an outpatient at another hospital for about one year. This time after she was first seen, Blumberug signs and peritonial signs became prominent and a laparotomy was performed for the most probable diagnosis of strangulated ileus. During surgery, there were a large quantity of yellowish transparent ascites and serositis like reddening and swelling of the entire small intestine. Since the patient had an underlying disease of SLE, administration of steroid was started after the operation with the diagnosis of acute lupus peritonitis. Consequently, those abdominal findings completely disappeared. Lupus peritonitis is an internally manageable peritonitis. In order to avoid useless laparotomy, we must keep lupus peritonis in mind as a probable differential diagnosis for acute abdomen in patients with previous history of SLE, especially juvenile and middle-aged women.

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Two cases of retroperitoneal leiomyosarcoma resedted completely are reported.
Case 1: A 56-year-old man was admitted to the hospital because of a hard mass with the size of 7.9×7.3×4.1cm in the right lower abdomen. There was no evidence of invading the digestive or urinary tract at preoperative evaluation. The tumor was resected completely from the posterior peritoneal cavity without combined resection.
Case 2: A 55-year-old man was admitted to the hospital because of a hard mass with the size of 12.5×11.7×8.3cm in the right lower abdomen, compressing the right external iliac artery and vein. In this case, the lesion was resected completely with right external iliac vein. The vein was reconstructed with a Goretex graft. These two tumors were diagnosed as leiomyosarcoma by the findings of parisading, nuclear atypism, excessive mitosis, and positive staining for α-actin, histologically.
The patients are free from any signs of recurrence as of 52 and 11 months after the surgery, in case 1 and 2, respectively.
Retroperitoneal leiomyosarcoma is a rare entity. Many cases have had hematogenous metastasis when the primary lesions are detected, with resultant poor prognosis. On the other hand, local recurrence frequently occurs after resection of primary lesion in cases without metastasis. Complete resection is mandatory to improve the prognosis and in these cases without metastasis, complete resection of the primary lesion contributes to good prognosis.

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Gastroschisis is a congenital malformation of the anterior abdominal wall and needs emergency treatments immediately after birth. From 1978 to 1996, 10 neonates with gastroschisis were treated in the institution. In these patients, the process before surgery, operative methods and process after surgery were investigated.
Three patients before 1984 died with no relation to the operative methods. The cause of deathes were lung complication, persistent bowel obstruction and unknown, respectively. Seven patients after 1985 survived. Three of the seven patients had one-stage fascial closure. Two of the three patients had a prenatal diagnosis of gastroschisis and were delivered by Caesarean section without oedematous and fibrous changes of eviscerated intestines. In these patients, it was very easy to carry out one-stage fascial closure. One of the seven patients had respiratory and circulatory failure and elevations in liver enzyme levels due to an acute elevation in intra-abdominal pressure after one-stage fascial closure. Therefore we performed a second operation by Allen-Wrenn's (A-W) method 12 hours later from the first operation. From this experience, we think that intra-abdominal pressure should be measured for judging whether or not one-stage fascial closure is safe. Three of the seven patients had A-W method. One patient had remarkable and temporary elevations in liver enzyme levels due to the obstruction of the extra-hepatic portal vein. We should take enough care not to obstruct a portal vein when we cover eviscerated intestines with prosthetic sheets.

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A 70-year-old woman was admitted to the hospital because of a mass at the left lumbar area. Physical examination showed an elastic soft mass 10cm in diameter at the left lumbar area. Ultrasonography and computed tomography offered a diagnosis of superior lumbar hernia. At operation a well defined 2.5cm defect in the transversalis fascia, which forms the floor of the superior lumbar triangle, was found and fat tissue surrounding the kidney prolapsed from this defect. Operative repair was done by inserting a mesh-plug into the fascial defect and covering the superior lumar triangle with onlay patch of a Marlex Mesh. The postoperative course was uneventful and she han been followed for 4 months without evidence of recurrence.
Twenty-one cases including ours have been reported in the Japanese literature so far. Of these 21 cases, a mean age was 72 and the male-to-female ratio was 8:13. Lesions were located on the left side in 13 cases, on the right side in six cases, and on the both sides in two cases. No cases applicated mesh-plug method with tension-free herniorrhaphy have been repoprted as far as we could review. We would emphasize the usefulness of this procedure for superior lumbar hernia.

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We studied 109 cases of tension-free hernia repair for adult inguinal and femoral hernia during 26 months from March 1996 to April 1998. There were 73 cases of external inguinal hernia, 25 cases of internal inguinal hernia, four cases of internal and external inguinal hernia, and seven cases of femoral hernia. Operative procedure was mesh plug+onlay graft in all cases. Operating time was 43±15min. (mean±standard deviation: M±SD), and it came to 38±12min in recent 10 cases. No postoperative antibiotics has been administered since November 1996, but no case of mesh infection has been seen. Postoperative complications were observed in 19 cases, which included 13 cases of retension of exudate and one case of recurred left internal inguinal hernia. Postoperative pain was slight and the patients were possible to be discharged from the hospital on the next day of operation.
Tension-free hernia repair performed in a series of 109 cases of inguinal and femoral hernia is thought to be excellent method that is easy in operative procedure, short in operating time, offers less postoperative pain and stretching sensation, and is low in recurrence rate.

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