. Manual of operative surgery. and implant the distal end of the fistulous tractinto this. In v. Stubenrauchs case the, implantation into the duodenumcaused narrowing of the pylorus, so gastro-enterostomy was done. Resultwas failure due to necrosis of fistulous tract. Method II.—Expose the openings in gall-bladder and common duct. Packthe common duct with gauze and see if the bile will flow into the gall-blad-der; if it will, use the gall-bladder for the anastomosis; if it will not, then use theduct for this purpose. Expose the duodenum and pyloric portion of the the duodenum and
. Manual of operative surgery. and implant the distal end of the fistulous tractinto this. In v. Stubenrauchs case the, implantation into the duodenumcaused narrowing of the pylorus, so gastro-enterostomy was done. Resultwas failure due to necrosis of fistulous tract. Method II.—Expose the openings in gall-bladder and common duct. Packthe common duct with gauze and see if the bile will flow into the gall-blad-der; if it will, use the gall-bladder for the anastomosis; if it will not, then use theduct for this purpose. Expose the duodenum and pyloric portion of the the duodenum and stomach reflect a flap with pedicle above, about iinch wide and long enough to reach without tension to the opening in the gall-bladder or duct. This flap consists of all the coats of the viscus (peritoneal,muscular and mucous) (Fig. 711). Turn the flap upwards. Occlude theopening in the common duct by laying the serous surface of the flap over the distal end of the flap to the opening in the gall-bladder with a few. RECONSTRUCTION HILE DUCTS 58: catgut sutures. Close the wound in the stomach and duodenum, leaving roomfor a drainage-tube at the base of the flap. Introduce a drain between the gutand the gall-bladder. Partially close the external wound. Pack and drain. Result.—Complete immediate success. About six months afterwardsthere was slight and temporary evidence of local trouble. V. Stubenrauch suggests an improvement of Method II and also an alternateprocedure. Method III.—Make the gastro-duodenal flap as above, but unite its lateraledges over a drainge-tube (Fig. 712) so as to form a tube lined with mucousmembrane. Unite the free end of the flap to the opening in the gall-bladder(or in the common duct as the case may demand) (Fig. 713). Make a smallopening into the duodenum a short distance distal to the flap and throughthis make the end of the drainage-tube emerge. Unite, with sutures, twofolds of duodenal wall over the drainage-tube for a short distance
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