. Diseases of the gall-bladder and bile-ducts, including gall-stones . , a fingerinserted through the incision felt a stone, which was thenremoved; but had we trusted to a probe the calculus wouldhave been left. The duct is usually dilated sufficiently topermit digital exploration, which under such circumstanceswe should always advise, reserving a bent probe, or, betterstill, a slender bent scoop, for use where the duct is notcapacious enough for the finger. The hepatic duct and itsprimary branches can be readily explored, and in Case 217calculi were removed from them through an incision in th
. Diseases of the gall-bladder and bile-ducts, including gall-stones . , a fingerinserted through the incision felt a stone, which was thenremoved; but had we trusted to a probe the calculus wouldhave been left. The duct is usually dilated sufficiently topermit digital exploration, which under such circumstanceswe should always advise, reserving a bent probe, or, betterstill, a slender bent scoop, for use where the duct is notcapacious enough for the finger. The hepatic duct and itsprimary branches can be readily explored, and in Case 217calculi were removed from them through an incision in thecommon duct. GALL-STONES, OR CHOLELITHIASIS 255 The incision in the duct may now be closed by interruptedsutures in two layers, first the muscular and fibrous coatsbeing approximated, and secondly the serous margins; butif this be impracticable, the muscular and serous coats maybe sutured together, and additional Lemberts sutures maybe applied over all. A rectangular cleft-palate needle is a most convenientinstrument to employ in applying these deep sutures, though. Fig. 47.—Diagram to illustrate the First Sutures in Chole-dochotomy. doubtless a small circular intestinal needle and holder willanswer equally well, or the special needles and holdersuggested by Mr. Lane may be found more convenient. If a gall-stone be found in the hepatic duct, it may bereached by opening the common duct, and passing a scoopor forceps through this opening. Dr. Elliott recommends the application of the suturesbefore removing the stone. 256 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS This is certainly an advantage, though, if the ducts have tobe explored afterwards, the sutures are rather in the same advantages may be obtained by introducing thetwo end stitches before extracting the calculus, as when theyare drawn on, the edges are approximated and more easilysutured (Fig. 47). Professor Halstead advocates* the use of a small hammerwhich he has devised for facilitating the application of
Size: 1465px × 1706px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, bookpublishernewyorkwilliamwood
