Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . owel by way of the gall-bladder. Whether to do a cholecystostomy or a cholecystenterostomy may bedifficult to decide. In cases in which the patient is very sick, with glycosuriaor jaundice, the quicker operation is indicated. That is simple cholecys-totomy, leaving a gall-bladder fistula. If the condition of the patient isgood and there are no gall-stones or discoverable cholecystitis, permanentdrainage into the bowel is the operation of choice. For in many of the
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . owel by way of the gall-bladder. Whether to do a cholecystostomy or a cholecystenterostomy may bedifficult to decide. In cases in which the patient is very sick, with glycosuriaor jaundice, the quicker operation is indicated. That is simple cholecys-totomy, leaving a gall-bladder fistula. If the condition of the patient isgood and there are no gall-stones or discoverable cholecystitis, permanentdrainage into the bowel is the operation of choice. For in many of thesecases no recognizable inflammation or infection of the gall-tract may bepresent; and if there is no other discoverable cause for the pancreatitis thereremains nothing to do but drain the gall-bladder. Gall-bladder drainage undoubtedly has a curative effect, and this is 78: SURGICAL TRFA TMEX T probably due to the relief of pressure upon the pancreas. It permits freerdischarge of pancreatic secretions. Necrosis of the pancreas requires drainage by gauze or wick packing sothat the peculiar secretions shall find external tfl ft ni Tumors of the -Adenoma, carcinoma and sarcoma are allamenable to treatment by operation, and each has been successfully much of the gland is necessary for health is not known; but a number ofcases of complete pancreatectomy with recovery have been reported. _ Ifpossible some pancreatic tissue should be left, because, while it is possible THE ABDOMEN 783 to supply the external secretion of the pancreas, supplying the internalsecretion is difficult. Cysts of the pancreas are more common and much more hopefullytreated. The cyst is approached at one or the other sides of the medianline, preferably making the approach directly in front of the the cyst is to be attacked between the stomach and transversecolon, above the stomach, or below the transverse colon (Fig. 1459) mustdepend upon its place of greatest promine
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