The feasibility and availability of long loop Roux-en-Y (llRY) esophagojejunostomy following total gastrectomy was appraised through long-term follow-up study with special reference to assessment of the quality of life and the absorption of nutritional elements. One hundred twenty-eight patients who underwent this procedure during the past 15 years were evaluated as part of this study. Mortality and morbidity was based upon a clinical assessment, while the quality of life evaluation also included the administration of patient questionnaire. Assessment of the individuals' absorption of nutritional elements was performed by the balance-study method for tat, and D-xylose excretion test for cargbohydrates. The results obtained were as follows:
1. Operative mortality in this study laws very low (1.36%) compared to the avarage value for Japan.
2. The incidence of complications such as failure of anastomosis, pneumonia and wound infection was similarly low.
3. Cumulative five-year survival was much higher than the average value for Japan (54.8% for curative resection, 2.2% for non-curative resection).
4. Eighty percent of the survivours were considered to have had “excellent” or “good” quality of life.
5. The quality of life was directly proportional to the quantity of food intake and serum cholesterol level.
6. Results obtained from the balance-study method for fat and that from the D-xylose excretion test showed a close correlation.
7. The llRY group showed a significantly lower value on both the fat absorption test ansd the D-xylose excretion test than Billroth I group; however, no significant difference was observed between the llRY and Billroth II groups.
Based upon the results of thes study, llRY esophagojejunostomy was concluded to be an appropriate surgical procedure following total gastrectomy. This procedure dramatically improves the quality of life as measured by queationnarie and physiological testing.

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Over the 15-year period between May 1971 and April 1985, 320 patients with cholelithiasis underwent surgery in the 1st Department of Surgery, Gunma University School of Medicine, among which 87 patients who had undergone choledochotomy were investigated.
After the choledochotomy, primary closure was performed in 33 cases (37.9%), T-tube drainage in 31 (35.6%), choledochoduodenostomy in 16 (18.4%) and papilloplasty in 7 (8.0%). The primary closure was applied for cholesterol cholelithiasis which was judged as not having retention and pigment gallstone in bile duct without high-grade changes caused by cholangitis or passage disorders to the duodenum. Choledochoduodenostomy was the first choice whenever drainage was needed. Drainage was used for patients with high distension, and in aged and recurrent cases, and we were satisfied that the drainage effect was good, and no subsequent cholangitis resulted.
As there are many cases which can be treated with primary closure, the abuse of T-tube should be avoided except in cases of acute cholangitis, highly obstructive jaundice, cases in which stricture choledochus is to be prevented and cases with suspicion of residual stones.

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