The practice of surgery . ion of Dawbarns methodto cholecystostomy (Mayo inKeens Surgery). 178 THK AUDOMEN to escape. In order to diaiii the stump, stitch into it, with No. 00 phiincatjiut, a rubber tube surrounded with gauze and led out through astab-wound. In from six to ten days the catgut will be absorbed, whenthe drain may be withdrawn, leaving a fistulous tract which healsspontaneously. The simple maneuvers already described do not explain or accountfor the treatment of such complications as numerous stones in the ducts,stone in the ampulla of Vater, adhesions, Jistulce, and malignant di
The practice of surgery . ion of Dawbarns methodto cholecystostomy (Mayo inKeens Surgery). 178 THK AUDOMEN to escape. In order to diaiii the stump, stitch into it, with No. 00 phiincatjiut, a rubber tube surrounded with gauze and led out through astab-wound. In from six to ten days the catgut will be absorbed, whenthe drain may be withdrawn, leaving a fistulous tract which healsspontaneously. The simple maneuvers already described do not explain or accountfor the treatment of such complications as numerous stones in the ducts,stone in the ampulla of Vater, adhesions, Jistulce, and malignant stones in the ducts are sought by palpation and by they are long present, the ducts becomes so much dilated as easily toadmit a finger for exploration. If you are convinced of their pix^sencc,you may remove them by pushing them up into the cystic duct, by cut-ting down upon them through the common duct, or, sometimes, in thecase of stones in the hepatic duct, by fastening a drainage-tube into the. Fig. 97.—Holding purse-string while inverting cutmargins of gall-bladder opening (Mayo in Keens Sur-gery). Fig. 98.—Purse-stringsuture tied (Mayo in ). latter and leaving it in place, when, in the course of time, stones willescape through it or through its tract after its removal. Sometimes it isnecessary to perform a secondary operation for the removal of stonesat the time of withdrawing the hepatic tube. Stones in the ampulla of Vater may be removed by freeing the duo-denum, turning it over on the stomach, and opening the common ductfrom behind; or, better, one may approach the ampulla by oj^eningthrough the duodenum from the front. The duodenum, after being thusopened, must be stitched up. I prefer this latter method of approach:it is easy and direct, and involves no difficult dissection or the tearingup of adhesions. When the ducts are opened for the removal of stones, the incisionneed not be stitched up. Abundant gauze drainage insures a
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
