In the decade from 1981 to 1990, 30 patients underwent a posterior transsacral approach at the Aichi Medical University Hospital for their benign or malignant rectal lesions. The operation was classified into two procedures, consisting of the transsphincteric approach and transsacral approach, in order to cope with the condition of the anal sphincter muscles; whether they were divided or not. Eleven rectal tumors were successfully excised through the opened-up rectum by using the transsphincteric approach, and excellent results were obtained without any postoperative complications. Using the transsacral approach, 2 presacral dermoid cysts and 11 rectal lesions were easily removed under direct vision. Their prognoses were excellent. The transsacral approach was also applied for the resection of recurrent rectal cancers after a radical, abdominoperineal resection in 6 patients suffering from intolerable local symptoms. All the patients were free from these uncomfortable local symptoms after the surgery. The posterior transsacral operation is thus considered to be of value not only for resecting benign rectal and presacral lesions, but also for resecting malignant rectal tumors in frail subjects who are unfit for radical operation and/or recurrent rectal cancer.
In a 42 year old female, a fistula developed between the splenic vein and the pancreatic duct through the cavity of a pseudocyst in the tail of the pancreas and resulted in an extrahepatic portal hypertension. The fistula was visualized by endoscopic retrograde cholangiopancreatography and percutaneous transhepatic portography, then was successfully resected by surgery. The possible etiology of extended obstruction of both splenic and portal veins in chronic pancreatitis with pseudocyst was discussed.
A new hepatic blood flow diversion method was undertaken to investigate further the influence of pancreatic hormones and hepatic blood flow on the functional regeneration of the liver. The new technique does not use venograft. The splenic vein was dissected and anastomosed to the proximal portal vein, which supplied the right lobes, and the mesenteric vein was dissected and anatomosed to the left portal vein at the hilus of the liver, which supplied the left lobes.
Mongrel dogs weighing approximately 10 kg were used. The right lobe received pancreatico‐gastrosplenic blood. The left lobe received intestinal blood. After hepatectomy, which removed 10% from the right side and 40% from the left side, blood flow volume to the right and left lobes was almost equal. The right lobes increased in weight significantly more than the left lobes. The extraction rates of indocyanine green of the right and left lobes were not significantly different. The right lobe revealed typical regeneration histologically, but the left lobe showed no signs of atrophy. Although pancreatic hormones were sufficiently supplied to the left lobe through the hepatic artery, they were not degraded. Pancreatic hormones could be a modifying factor affecting the quantity of hepatic regeneration. The study of both the quantity and the functional quality of the regenerated liver is important.
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