. Modern surgery, general and operative. this layer Lembert or Halstedsutures are applied. A drainage-tube is inserted and a piece of iodoformgauze is placed upon the suture line, the other end being brought out of theabdominal wound. This precaution is taken because leakage may it is found impossible to suture the wound in the duct, the operation thenbecomes a choledochostomy (although this term is usually used only whenthe incised duct is stitched to the abdominal wall). The surgeon carriesa glass tube down to the opening and surrounds it with iodoform gauze, orinserts a rubber drai
. Modern surgery, general and operative. this layer Lembert or Halstedsutures are applied. A drainage-tube is inserted and a piece of iodoformgauze is placed upon the suture line, the other end being brought out of theabdominal wound. This precaution is taken because leakage may it is found impossible to suture the wound in the duct, the operation thenbecomes a choledochostomy (although this term is usually used only whenthe incised duct is stitched to the abdominal wall). The surgeon carriesa glass tube down to the opening and surrounds it with iodoform gauze, orinserts a rubber drainage-tube into the opening and carries it up toward thehepatic duct, or makes an incision into the right loin after the plan of Ruther-ford Morison, and carries a tube into the right kidney pouch, which is themost dependent part of the peritoneal cavity when the patient is I always drain the duct, when I have opened it for stone, carrying^ A. W. Ma3-o Robsons Treatise on Diseases of the Gall-bladder and Fig. S13.—Suture of duct over Halsteds hammer. 1270 Diseases and Injuries of the Abdomen the tube up toward the hepatic duct. The same reasons which cause us todrain the gall-bladder after removing stones should influence us in this case. Robson (Lancet, April 22, 1902) has performed the operation of chole-dochotomy 60 times. In 10 cases of stone in the common duct he manipulatedthe stone back into the gall-bladder and removed it through an incision in thatviscus by means of a scoop. The above maneuver is impossible unless the cysticduct be dilated. In 30 cases he crushed the stones between his finger and thumb,but this is only possible when the stones are soft, and it has the objection thatit may leave fragments. If a stone is lodged in the common duct and cannotbe manipulated back into the gall-bladder, choledochotomy should be mortality in 60 cases of choledochotomy was per cent. Since1900 his mortahty has been pe
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