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In a consecutive series of 26 patients (10 men and 16 women) undergoing abdominoperineal resection of the rectum, cystometry and pressure-flow-EMG measurements were made preoperatively and three and 6-12 months after operation. Two patients developed neurogenic bladder paresis (7.7%, 95% c.l. 1-25%). Men with even slight complaints of bladder outlet obstruction preoperatively ran a risk of postoperative aggravation demanding surgery. In women no significant changes in micturition patterns were found. It is concluded that urinary flow measurement and cystometry should be available as minimum screening procedures after abdominoperineal resection of the rectum to detect bladder dysfunction at an early stage.

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EDITORIAL SYNOPSIS A report is given on four non-cirrhotic patients in whom the hepatic artery proper was ligated for different reasons. In the post-operative course only slight signs of liver damage were present and no later sequels were observed.Ligation of the hepatic artery central or distal to the point of origin of the gastroduodenal tributary has for several years been used in the treatment of patients with cirrhosis of the liver. On the other hand it has so far been generally accepted that ligation of the hepatic artery in patients with a normal liver is followed by serious complications, especially if the hepatic artery is tied peripherally to the gastroduodenal tributary.In the present communication four non-cirrhotic patients are described, who, during surgery, had the hepatic arterial blood supply interrupted during peripheral ligation of the hepatic artery. Only slight and transient symptoms of liver damage were demonstrated in the post-operative period in these four cases.CASE REPORTS CASE 1 A woman of 64 with symptoms for four years of biliary tract disease underwent a cholecystectomy and choledochotomy. The immediate post-operative course was uneventful, but four weeks after the operation she had a severe haematemesis and was admitted to this hospital. On examination an oesophageal hiatal hernia, a slightly deformed duodenal bulb, and a diverticulum of the duodenum were found, and, though oesophagoscopy did not reveal any peptic ulcer, the bleeding was thought to be due to the hernia and a transthoracic herniotomy was performed. Two weeks after the second operation she had a second severe haematemesis and a further operation was necessary, this time a bleeding duodenal ulcer being suspected. At operation, however, no abnormality was found in the ventricle and duodenum, but during duodenotomy it was observed that the bleeding originated in the deep biliary tracts as pulsating bleeding through the papilla of Vater was seen. By choledochotomy near the cystic duct it was seen that the bleeding came from the hepatic duct. As immediate haemostasis was vital at that stage of the operation the hepatic artery was ligated distal to the pancreatic-duodenal artery after which the bleeding quickly stopped.After the operation penicillin (2 m. units twice daily) and streptomycin (1 g. daily) were given for 11 days.On the third post-operative day the serum transaminases showed slightly raised values: glutamic-oxalic acid transaminase (S-GOT) 2.8 units (normal < 17), glutamic-pyruvic acid transaminase (S-GPT) 5.5 units (normal < 1-5) but on the twelfth day after the operation all values were normal. Serum bilirubin, thymol turbidity, and alkaline phosphatases were normal postoperatively and paper electrophoresis showed the following values: Albumin 197, alpha, 070, alpha2 094, beta, 057, beta2 043, and gamma globulin 1-30 g./100 ml.The patient left the hospital well 32 days after the last operation.She was readmitted 13 months later on account of a ventral hernia. She had been completely well since the ligation o...