. A manual of operative surgery . inflam- mation of its walls. 6. Long persistence of a biliary fistula after drainage. This may, however, indicate another stone in thecommon bile duct, which will require new growth (adeno-carcinoma), limited to the gall-bladder,is an obvious indication for cholecystectomy, but such casesare very rare. We have excised the gall-bladder with a wedge-shaped piece of the liver above it in one case in which the infil- * Cholecystectomy prevents the risk of cancer of the gall-bladder following, ata considerable interval, removal of gall-stones. This risk,
. A manual of operative surgery . inflam- mation of its walls. 6. Long persistence of a biliary fistula after drainage. This may, however, indicate another stone in thecommon bile duct, which will require new growth (adeno-carcinoma), limited to the gall-bladder,is an obvious indication for cholecystectomy, but such casesare very rare. We have excised the gall-bladder with a wedge-shaped piece of the liver above it in one case in which the infil- * Cholecystectomy prevents the risk of cancer of the gall-bladder following, ata considerable interval, removal of gall-stones. This risk, though small, is a realone, and we have known one case of its occurrence. CHAP. II] CHOLECYSTECTOMY 157 tration was apparently limited. It was doubtful if the operationprolonged life, death resulting from widespread cancer of theliver three months later. To the indications for cholecystectomy given above, F. (Clin. Joum., May 2nd, 1906) adds simple dilatation of thegall-bladder. This is commonly due to a single large stone. FIG. 46.—CHOLECYSTECTOMY. The peritoneum (p. f.) is raised in two flaps from the under-surface of the gall-bladder (g. b.).A ligature (l.) has been tied round the cystic duct near its junction with h. d. , the hepaticduct. The upper end of the divided cystic duct has been secured before division in aclamp (f.). The cystic artery (c. A.) has been doubly ligatured and divided. The gall-bladder is being peeled off the under-surface of the liver from below upwards. c. B. D.,Common bile duct. impacted at the upper end of the cystic duct, and experiencehas shown simple removal of the calculus and drainage to bemost satisfactory. When the stones are multiple and havecaused cholecystitis, there is more reason to fear recurrenceof the trouble in after years unless the gall-bladder be (loc. cit.) narrates three cases of such recurrence in whichhe ultimately performed cholecystectomy. It should be remem-bered that removal of the gall-bladder do
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