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Seventy surgical cases of ventral incisional hernia performed in our department during the past 15 years were examined regarding background factor, primary disease for the previous operation, location of hernia, subjective symptoms lapse of time before onset of symptoms, and operation procedure. In addition preoperative complications (cure prolonging factor) and postoperative course were studied in 24 cases which were previously operated on at the department. Incisional hernia tended to be frequent in female patients after receiving emergency operations for benign conditions. Most cases occurred within one year after the previous surgery. An important determinant of the hernia was preoperative complications at the previous operation, which occurred in 75.0% of the cases. A relationship between hernia and postoperative complications of the previous operation such as wound infection and wound dehiscence was also suggested. Simple layer-to-layer closure operation had a hernia recurrence rate of 10%. Artificial fascia prosthetic operation, with a recurrence rate of 3.0%, is considered a useful surgical treatment method for large hernias and recurring cases.

We evaluated the insertion of a metallic stent for improvement of quality of life (QOL) as a therapeutic guideline for carcinomas of the left colon causing intestinal obstruction. Postoperative complications of patients with colorectal cancer treated at the department in a recent one-decade included postoperative infection of surgical wound in frequencies of 23.5% and 41.9% for elective and emergency operations, respectively. No such wound infection occurred in the stent inserted cases. Postoperative suture failure was noted in 11.8% of ileus cases undergoing elective surgery, 16.1% of those undergoing emergency operation, and 6.7% (one case) of stent cases. With Barium enema following the stent insertion a multiple cancer was detected. Artificial anus which causes a decline of QOL was made in 4 cases (26.7%) of the stent cases, but no artificial anus was made for coprostasis. It is concluded that the insertion of the metallic stent contributes to a decrease in postoperative complications and makes the artificial anus unnecessary, namely, the insertion of the metallic stent has obviously improved the QOL of patients with colorectal cancer.

In the operation for gastric cancer, reversed T-shaped incision and mountain-shaped trnasverse incision (which are regarded as transverse incision in the following description) were compared with the conventional epigastric midline incision for the efficacy. Subjects were 62 resectable cases of gastric cancer undergoing transverse incision at the department in a recent 4-year period from January 1991 and 1990 resectable cases of gastric cancer undergoing midline incision in the same period. Both patients groups were compared for background, operative, and postoperative factors. Transverse incision, especially reversed T-shaped incision was often employed when expanded dissection was performed for advanced gastric cancers. The patients subjected to transverse incision predomonantly had an advanced cancer before surgery. There were no other significant background factors. As to operative factors, extended operation, prolonged operating time, and increased bleeding volume were noted in the transverse incision group compared to the other. Postoperative pain control could be easily done in the transverse incision group. Although observation period was still short, no postoperative intestinal obstruction or peritoneal hernia due to intestinal adhesion to the surgical wound in the abdominal wall occurred in the patients of transverse incision group.