. Manual of operative surgery. oduction of i, 2 or even 3 liters of hypotonic salt solution has saved a HEPATICUS DRAINAGE 581 number of otherwise hopeless patients. In acute septic nephritis Matas hasperformed cholecystostomy on the normal gall-bladder and saved his patientby instilling much warm Vichy Celestin. (C) Hepaticus drainage. Through the wound in the common duct in-troduce a drainage tube upwards to beyond the opening of the cystic best tube to use is a soft-rubber catheter (No. 25 to 30 F.), with its endcut off and a lateral opening made about ^ inch from its extremity. Fi
. Manual of operative surgery. oduction of i, 2 or even 3 liters of hypotonic salt solution has saved a HEPATICUS DRAINAGE 581 number of otherwise hopeless patients. In acute septic nephritis Matas hasperformed cholecystostomy on the normal gall-bladder and saved his patientby instilling much warm Vichy Celestin. (C) Hepaticus drainage. Through the wound in the common duct in-troduce a drainage tube upwards to beyond the opening of the cystic best tube to use is a soft-rubber catheter (No. 25 to 30 F.), with its endcut off and a lateral opening made about ^ inch from its extremity. Fixthe tube to the wound by a catgut stitch (Fig. 709). Close the excess of thewound in the duct and the hepato-colic omentum by a continuous catgutstitch. Drain the gall-bladder with a dressed rubber draim Between theneck of the gall-bladder and the wound in the common duct, place a stripof iodoform gauze. With fine catgut stitch the end of a large spUt rubbertube to the common duct immediately below the exit of the drain. (The. Fig. 710.—Cholecystostomy and hepaticus drainage. same suture used for closing the duct wound is suitable for fixing the largesplit tube.) Make the split tube embrace or almost embrace the common ductdrain, the gall-bladder drain the strip of gauze and any other drain whichmay be required (Fig. 710). Tie a thread of catgut round the spht tube soas to hold all these drains together, and let them all protrude, as one, throughthe abdominal wound. Another method of reaching the calculus, viz., by splitting the gall-bladderand both the cystic and common ducts, is described under cysticotomy. When the obstructing calculus exists very low down in the common duct,one may reach it by the transduodenal route. McBurney (Annals of Sur-gery, Oct., 1893) was the first to perform this operation of duodeno-choledo-chotoniy. Kocher is a supporter of the method. Mayo Robson thus describesthe procedure: The termination of the common duct, including the duodenum, shouldbe
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