. Diseases of the gall-bladder and bile-ducts, including gall-stones . Fig. 51.—First Stage of the Button Operation. margins of the openings to slough, and that the true bond ofunion is only slight at first, so that it is well to keep thepatient absolutely quiet for at least a fortnight, lest the newbond of union should give way and permit of extravasationof the visceral contents. In considering the question of cholecystenterostomy, ithas to be borne in mind that the operation can only be done 288 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS when the gall-bladder is of moderate size or dilated,
. Diseases of the gall-bladder and bile-ducts, including gall-stones . Fig. 51.—First Stage of the Button Operation. margins of the openings to slough, and that the true bond ofunion is only slight at first, so that it is well to keep thepatient absolutely quiet for at least a fortnight, lest the newbond of union should give way and permit of extravasationof the visceral contents. In considering the question of cholecystenterostomy, ithas to be borne in mind that the operation can only be done 288 DISEASES OF THE GALL-BLADDER AND BILE-DUCTS when the gall-bladder is of moderate size or dilated, andthat it is inapplicable to the difficult class of cases wherea gall-stone is impacted in the common duct and the gall-bladder is atrophied. When it can be done, the anastomosis should be made tothe duodenum ; but, if preferred, a free loop of jejunum maybe selected and brought over the hepatic flexure of the Fig. 52.—Last Stages of the Button Operation. Only in exceptional cases should the anastomosis be madebetween the gall-bladder and colon. The statistics according to Murphy, given in the Transac-tions of the International Congress at Rome, are :23 cases by suture, with 8 deaths = 34 per cases for gall-stone by button, no cases for malignant disease, with 2 deaths =100 percent. GALL-STONES, OR CHOLELITHIASIS 289 From a report up to 1897, which Dr. Murphy was sokind as to furnish, cholecyst-duodenostomy had been per-formed with the aid of the anastomosis button in 67 non-malignant cases, with only 3 deaths, these being due tocontinuous haemorrhage from laceration of the liver sub-stance on the seventh day, to cholaemia on the fourth day,and to septicaemia on the fourth day, respectively. Of his12 malignant cases 10 died, giving a mortality of 83*3 percent. My own cases are 17 in number, with 3 deaths. Of these12 were done for gall-stones alone or fistula, and all reco
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