Abstract
The surgical approach to the treatment of diabetes mellitus has taken 4 routes in the human. Goldjanitski 1 and others ligated the parotid duct but with little success. Dubious results have been obtained by adrenal denervation (Ciminata 2 ) and by liver denervation (Depisch et al 3 ). Mansfeld's 4 studies in dogs established the pancreas as the fourth method of approach. He ligated the tail of the pancreas in dogs and obtained results which indicated an increase in sugar tolerance. DeTakats and Wilder 5 modified Mansfeld's technique and instead of ligating the tail of the pancreas, they isolated it by section with cautery and wrapped it in omentum. This operation was performed in one case of juvenile diabetes. Subsequently DeTakats 6 employed the original Mansfeld technique in 2 other cases of juvenile diabetes but used a piece of fascia for the ligature. In none of his cases did he get any noteworthy improvement.
Four years ago, we studied the effects of mass ligation of the pancreas about one inch from the head of the gland in dogs. Histological examination of the pancreas 6 to 8 weeks after this operation revealed a shrinkage of the caudal portion to about one-tenth of the original size, due to extensive fibrosis in the entire acinar tissue of that portion. The only remaining parenchyma consisted of markedly hypertrophied islet tissue.
We felt that patients with diabetes mellitus might be improved if the ligation were nearer the head of the pancreas. The consequent acinar atrophy would be of greater extent and the concomitant changes in the islet tissue of greater magnitude. Three patients suffering from severe diabetes mellitus were therefore treated in this manner.
For several weeks before operation, the patients'carbohydrate tolerance was studied. They were operated under spinal analgesia.
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