The practice of surgery . nels, and through ac-cidental adhesions between the vessels of the portal system and thoseof the systemic circulation. By multiplying the adhesions he hopedto multiply the anastomoses, and thus diminish the portal congestion. - R. B. Greenough, Amer. Jour. Med. Sci., December, 1902. 164 THE It is obvious that even if ahuiuhint collateral anastomoses arc thusestablished, so that the liver circulation is relieved, still little improve-ment in the disease process within the Hver can be anticipated. More-over, considerable experience has now shown that Talmas ope
The practice of surgery . nels, and through ac-cidental adhesions between the vessels of the portal system and thoseof the systemic circulation. By multiplying the adhesions he hopedto multiply the anastomoses, and thus diminish the portal congestion. - R. B. Greenough, Amer. Jour. Med. Sci., December, 1902. 164 THE It is obvious that even if ahuiuhint collateral anastomoses arc thusestablished, so that the liver circulation is relieved, still little improve-ment in the disease process within the Hver can be anticipated. More-over, considerable experience has now shown that Talmas operationis api)licable in cases of hypertrophic cirrhosis only, and not to casesof atrophic cirrhosis—certainly not to cases of acute yellow another operation, devised by Terrier, of Paris, is performed forthat condition known as biliary cirihosis—the Hanots cirrhosis ofthe French. The presumption is that bihary cirihosis is due to aninfection of the liver through the bile-passages. Tenier, and later Dela-. Fig. 88.—Schiassis modification of Talmas operation. geniere, undertook to side-track the infecting bile, and so to relievethe hver, by draining the gall-ducts through the gall-bladder—chole-cystostomy. In certain cases this operation has been beneficial. M,L. Harris, in an admirable essay in 1903, pointed out that the twoforms of cirrhosis susceptible of surgical treatment sometimes may co-exist, and he advocated a combination of Talmas ojjeration with gall-bladder drainage in suitable cases. Gall-bladder drainage is indicatedwhen there is evidence of hepatic infection—localized pain over the 1 See account of case reported by Wilder Tileston, in Boston Med. and , 1908, vol. clviii, p. 609. HEPATOPTOSIS 165 bile-ducts, tenderness, fever, chills, enlarged liver, occasional jaundice,but no ascites. Talmas method of establishing a collateral anastomosis aroundthe liver is known as omentopexi/—fastening the omentum to theparietal peritoneum. The
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