Operative surgery . stones. For this pur-pose a probe can be carefully used to push the stone along. The injectionof fluids to dissolve the stone is exploited, but it can not be regarded withfavor. The practice of closure of the gall bladder and its return to theabdominal cavity, with immediate closure of the abdominal wound (chole-cystendysis), should be practiced with discretion. The temporary advan-tages gained by this course do not always, in our judgment, otfset the dan-gers that may follow it. The Remarks.—If the bladder be not much distended, aspiration can beomitted and a free incision
Operative surgery . stones. For this pur-pose a probe can be carefully used to push the stone along. The injectionof fluids to dissolve the stone is exploited, but it can not be regarded withfavor. The practice of closure of the gall bladder and its return to theabdominal cavity, with immediate closure of the abdominal wound (chole-cystendysis), should be practiced with discretion. The temporary advan-tages gained by this course do not always, in our judgment, otfset the dan-gers that may follow it. The Remarks.—If the bladder be not much distended, aspiration can beomitted and a free incision made at once, the fluid being caught by spongesor conducted away by a small trough of rubber tissue, oiled silk, etc. Thedirection of the abdominal incision is varied according to the predilection ofthe operator, the needs for observation and manipulation of the organs, andthe preservation of the abdominal nerves. Keen advises that it be madeparallel with the cartilaginous borders of the ribs; fzer^^ recommends a. Fig. 101(5.—Murphysmodified button fordrainage in cliole-cystotomy. ()iM:i:Ari()NS on viscioka connkctki) wiiii IliinroxjiiM. ^09 ri,f,ht-iUi<;lo(l incision, so ))liu-(Ml tluit the fiiiHliis of the l)l;i(ldcr sli;ill lie be-tween the viTticul and hori/ontal j)arts of the cut. The {^Midiron dissec-tion of (Jreig Stnitli is often of ample dimension, and, like the others, can beextended to meet the requirements by division of the muscular fibers, ffoingeven into the rectus abdominis if need be. In tiiis plan the natural tendencyof the separated libers to come together prevents undue subsequent weaken-ing of the abdominal wall at the seat of operation. A vertical incision inthe linea semilunaris is convenient for explorative purposes. It may benecessary to break up connecting adhesions before the bladder can bebrought into the wound sutliciently to pievent ])critoneal infection. If thegall bladder be ailherent to the abdominal wall already (one stage), or besewed
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Keywords: ., bo, bookcentury1800, bookdecade1890, bookidoperativesurgery02brya
