. Annals of surgery. , as may be seenfrom the cases reported in this paper. Technique.—The objection to immediate suture of the ductsis the difficulty of the operation and its supposed speaks of the great difficulties of sewing the commonduct, and used a Ferguson speculum to expose the duct in itsdeep position, Cabot used a hooked knife to incise the duct bytouch. As I have found the operation less difficult than I ex- 1 Bui. Soc. Chirurgie, XX, p. 572, 1894. SUTURE OF THE GALL-DUCTS AND GALL-BLADDER. 97 pected, I will give the method by which I sutured the hepaticand common d
. Annals of surgery. , as may be seenfrom the cases reported in this paper. Technique.—The objection to immediate suture of the ductsis the difficulty of the operation and its supposed speaks of the great difficulties of sewing the commonduct, and used a Ferguson speculum to expose the duct in itsdeep position, Cabot used a hooked knife to incise the duct bytouch. As I have found the operation less difficult than I ex- 1 Bui. Soc. Chirurgie, XX, p. 572, 1894. SUTURE OF THE GALL-DUCTS AND GALL-BLADDER. 97 pected, I will give the method by which I sutured the hepaticand common duct. The patient is hung by straps under thearms on an inclined plane at an angle of something less thanforty-five degrees. A sand-bag is placed under the back, sothat the patient is bent over it. In this position the intestinesgravitate to the lower part of the abdomen, so that when theliver is held up by a retractor the air sucks in between the liverand intestines much as it enters the pelvis in the Trendelenburg. The duct is held by thumb and finger of left hand. The stitches areplaced before the stone is removed. position. The abdomen is opened in the right linea gall-bladder is seized and pulled up, and the course of theducts is palpated with great care. When a stone is found, therest of the ducts should be palpated with especial care, as thesuccess of the suture depends on the unobstructed flow of thebile. When a stone is found, it is grasped with the thumb andfinser of the left hand and raised to as convenient a level aspossible. The fingers should not be removed from the duct7 98 JOHN WHEELOCK ELLIOT. until the stitches are tied. The duct is incised over the stoneby a longitudinal cut. The stitches are then placed in the sidesof the duct before the stone is removed (see Fig.); for the instantthe stone is removed the duct collapses and the wound is bathedin bile and cannot be brought into an accessible position the stone is removed the fingers
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