Operative surgery, for students and practitioners . tripgauze to prevent any leakage during the subsequent steps of theoperation. OPERATIONS UPON THE GALL-DUCTS. 521 The protecting gauze pads are again properly arranged, onepacked carefully down under the liver into the right kidney spaceand the operator proceeds to remove the stones from the commonduct. Two fingers of the left hand are introduced, behind thecommon duct, into the foramen of Winslow and the duct drawnforward toward the abdominal incision and it and the stone withinthus steadied while an incision is made through its wall, cuttin
Operative surgery, for students and practitioners . tripgauze to prevent any leakage during the subsequent steps of theoperation. OPERATIONS UPON THE GALL-DUCTS. 521 The protecting gauze pads are again properly arranged, onepacked carefully down under the liver into the right kidney spaceand the operator proceeds to remove the stones from the commonduct. Two fingers of the left hand are introduced, behind thecommon duct, into the foramen of Winslow and the duct drawnforward toward the abdominal incision and it and the stone withinthus steadied while an incision is made through its wall, cuttingdirectly down upon the stone. The incision is just large enoughto permit the extraction of the stone. When the stone is removedbile may escape and is wiped away as fast as it flows. The fingeris introduced into the duct or a probe, if the duct is too small toadmit the finger, and search is made for any remaining finger is passed upward and downward in the duct in examiningfor additional stones. At times calculi are impacted low down in. Fig. 238.—Method of Suturing Incision in the Common Duct. The suturesappear in the edges of the incision just short of the mucous layer. They donot penetrate the entire thickness of the wall of the duct—they do not pre-sent within the lumen of the duct. the duct and may be dislodged and worked upward into the upperpart of the duct and removed through the incision. The incision in the common duct may be closed with a con-tinuous or several interrupted sutures of fine chromic catgut. Thesesutures enter and exit close to the edges of the incision, but theymust surely not penetrate the mucous layer—they must not appearwithin the lumen of the duct—they appear in the edges of theincision just short of the mucous layer. As to the advantage ofclosing the incision in the duct there is considerable difference ofopinion. If the incision is closed a drain made of strip gauzewrapped in rubber tissue may be left in the abdomen, reachingdow
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