Yasunori Sawabe

A new method of hernioplasty for adult groin hernias centering on repair of the transversalis fascia

A new method of hernioplasty for adult groin hernias centering on repair of the transversalis fascia was assessed by a questionnaire conducted every five years on adult patients who had received the above operation. The efficacy of this method was evaluated in terms of the postoperative quality of life and prevention of recurrence of groin hernias. Over the last 9 years, 834 adult patients with 921 groin hernias, including bilateral lesions, have undergone the above procedure and overall, favorable results were obtained, with only one case of recurrence (0.1 per cent) being reported. Contralateral herniation, which has been often reported following Bassinis or Hatakoshis method, was found in only one of our patients although the number of patients who complained of pain in the operated region was comparatively high, being 51 cases or 11.4 per cent.

Intraperitoneal rupture of the ureter as a cause of generalized peritonitis : Report of a case

We report a rare case of generalized peritonitis caused by nontraumatic, intraperitoneal rupture of the ureter. An 80-year-old woman with a history of bilateral vesicoureteral reflux and long-term urethral indwelling catheter drainage presented with a very distended abdomen. Computed tomography showed massive ascites and intraperitoneal free gas. We performed an emergency laparotomy, assuming a gastrointestinal perforation; but could not find a cause of generalized peritonitis. Postoperatively, she presented with anuria and massive peritoneal drainage. The findings of a cystogram confirmed intraperitoneal ureteral rupture. She was managed successfully with ureteral stenting. The diagnosis of this condition requires a high degree of clinical suspicion, along with radiographic evidence and peritoneal fluid analysis. Image-guided interventions play a crucial role in the management of ureteral urine leaks after a correct diagnosis has been made.

Intraoperative Peritoneal Hyperthemia to the Gastric Cancer with Serosal Invasion.

漿膜浸潤陽性胃癌21例を対象として, 腹膜再発の予防と予後の改善を目的として, Cisplatinをもちいた術中の腹腔内温熱化学療法 (IPH) を考案し施行した.その結果, 最長1年7か月経過中であるが, IPH施行群には腹膜再発による死亡はなく, Kaplan-Meier法による予後検定でも, 切除胃癌症例で深達度ssγ, se, seiをあわせたhistorical control群に比較し9か月の時点で, IPH施行群19例が生存率88.0%に対しcontrol群82例は66.1%と5%以下の危険率で有意の予後の改善をしめした.また, 最も腹膜再発をきたしやすいBorrmann 4型胃癌では, 1年7か月の時点において, IPH施行群6例の生存率100%に対しcontrol群22例の生存率は24.9%で0.1%以下の危険率で有意に予後が改善した.このような結果から, 本法は漿膜浸潤陽性胃癌において, 腹膜再発予防にきわめて有効な方法であると考えられた.