Operative surgery, for students and practitioners . s described in detail in choledochotomy. Stones impacted in the hepatic duct may be removed by splittingthe cystic duct (with or without extirpation of the gall-bladder) downas far as its junction with the common. Through the opening thusmade the stones may be removed from the hepatic duct. Choledocliotoniy. — Incision into the common bile-duct. Thisoperation is performed for the purpose of removing calculi which havebecome lodged in the duct. Calculi may become impacted in any partof the common duct, in the upper supraduodenal part, in the l
Operative surgery, for students and practitioners . s described in detail in choledochotomy. Stones impacted in the hepatic duct may be removed by splittingthe cystic duct (with or without extirpation of the gall-bladder) downas far as its junction with the common. Through the opening thusmade the stones may be removed from the hepatic duct. Choledocliotoniy. — Incision into the common bile-duct. Thisoperation is performed for the purpose of removing calculi which havebecome lodged in the duct. Calculi may become impacted in any partof the common duct, in the upper supraduodenal part, in the lowerretroduodenal part or in the lower end of the duct, in the intramuralportion or in the ampulla of Vater—the dilated part of the duct justbefore it opens into the duodenum. There may be only one calculus,frequently there are several or they may be very numerous. They maybe lodged loosely in the common duct being thus able to change theirposition from time to time and permitting the bile to flow past them, OPERATIONS UPON THE GALL-DUCTS. 519. Fig. 237.—Choledochotomy. Two fingers have been passed into the foramenof Winslow and the common duct lifted forward into the abdominal incision has been made through the wall of the common duct down upona stone contained within. 520 ABDOMEN AND BACK. or they may be impacted so snugly in the duct that they obstruct theflow of bile completely and cause symptoms accordingly. Supra-duodenal Choledochotomy. — A sand-bag is placedunder the lower dorsal region and the table inclined so that the headis five or six inches higher than the foot. The primary incision from the tip of the ninth costal cartilage(eholecystostomy), is enlarged by carrying it upward and inward,parallel with the free border of the ribs, toward the ensiform cartilage,for a distance of two or three inches—Eobson incision. After the abdomen has been opened the protecting gauze pads aretucked into the incision and adhesions carefully separated and a pre-
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