The practice of surgery . ompanied by great prostration. As for class (c), it must be obvious that with an obstructive jaundice,due to tumor occluding the ducts, a cholecystostomy is essential forpermanent drainage. Cholecystectomy is probably no more dangerous than cholecystostomyif it be performed for such simple conditions as are demonstrated inclass (a); but, as a matter of fact, cholecystectomy is employed in more THE BILE-PASSAGES 175 serious conditions. There are two important indications for cliolecys-tectoniy: (d) Disease crippling the cystic duct. (e) Disease crippling the gall-bladd
The practice of surgery . ompanied by great prostration. As for class (c), it must be obvious that with an obstructive jaundice,due to tumor occluding the ducts, a cholecystostomy is essential forpermanent drainage. Cholecystectomy is probably no more dangerous than cholecystostomyif it be performed for such simple conditions as are demonstrated inclass (a); but, as a matter of fact, cholecystectomy is employed in more THE BILE-PASSAGES 175 serious conditions. There are two important indications for cliolecys-tectoniy: (d) Disease crippling the cystic duct. (e) Disease crippling the gall-bladder. .These two—(d) and (e)—often are interdependent, and are fre-quently present together. We perform cholecystectomy when thecystic duct is crippled, because cholecystostomy, in that case, wouldnot drain properly the ducts, and would leave a gall-bladder subjectto subsequent disease. For much the same reason we remove a gall-bladder when it is crippled, because leaving it would mean leaving anidus for future Fig. 94.—Position of patient for operation on liver and bile-passages. Classes (d) and (e) are wont to be concerned with further advancedand complicating disease, such as fistulse and adhesions involving otherorgans. Here are certain words which demand definition. Cholecystendysisis an antiquated procedure. It means opening the gall-bladder, re-moving its stones, and sewing it up again. This is dangerous and un-certain, for leakage may occur. Choledochotomy and choledocholithotomijmean opening the common duct and removing stones. Cholecystenter-ostomy means forming an anastomosis between the gall-bladder andthe bowel. I have found this last operation useful in the case of per-manent obstruction of the common duct or cicatricial stenosis bymahgnant disease, .pancreatic disease, or cicatricial obstruction. Itshould not be done if the obstruction can be removed, or in malignantdisease of the pancreas with gall-bladder distention when the patientis extremely re
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