. Manual of operative surgery. horough dissection. Suture thecut edges of the peritoneal folds from beside the stump up to the edge of theliver, removing the gall-bladder little by little as the sutures are being a small cigarette drain or roll of rubber dam down to the stump of thecystic duct and along the fissure from which the gall-bladder was removed(Fig. 704). 5 74 OPERATIONS ON THE BILIARY PASSAGES Cholecystenterostomy.—When the common duct is irreparably occluded,, by malignant disease, or when it is desirable to drain the ducts in chronicpancreatitis, the formation o
. Manual of operative surgery. horough dissection. Suture thecut edges of the peritoneal folds from beside the stump up to the edge of theliver, removing the gall-bladder little by little as the sutures are being a small cigarette drain or roll of rubber dam down to the stump of thecystic duct and along the fissure from which the gall-bladder was removed(Fig. 704). 5 74 OPERATIONS ON THE BILIARY PASSAGES Cholecystenterostomy.—When the common duct is irreparably occluded,, by malignant disease, or when it is desirable to drain the ducts in chronicpancreatitis, the formation of a fistula between the gall-bladder and the gutpermits the escape of bile. This operation is cholecystenterostomy. (A) Antero-colic method. When possible, it is best to unite the gall-bladderto the duodenum but under stress of circumstances that portion of the intestine(even the colon) which is most readily brought up against the gall-bladder isthe best portion to use. The operation itself is practically identical with that. IlG. 704.—{Judd, Annals of Surgery.) of entero-enterostomy (intestinal anastomosis) and requires no special descrip-tion. It may be accomplished by the method of suture, by McGraws elasticsuture, or by the Murphy button. Probably the oldest patient ever submittedto this operation was a woman eighty years of age, in whom the author success-fully used the Murphy button. Before the operation of choledochotomy wasas safe as it is to-day, cholecystenterostomy was much more frequently resortedto than at present; it averted the evils from obstruction of the common duct bystones, but it did not rid the patient of the obstruction itself or of the late effectsof the irritation from the obstructing calculus. CYSTICOTOMY 575 When the gall-bladder is anastomosed to a segment of small intestine, ithas been suggested that an anastomosis between the afferent and efferentsegments of the gut would prevent all possibility of intestinal contents gaining,access to the gall
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