. Diseases of the gall-bladder and bile-ducts, including gall-stones . Fig. 50.—Diagram to show Application of Serous Suture in theBone Bobbin Operation. it is dissolved, and the mucous and serous sutures effectuallyprotect the channel from leakage. If the Murphy button be used, the smallest size is selected,and two running sutures are applied, as shown in the the gall-bladder has been emptied, and the bowelclamped either by Murphys intestinal clamps or Lanesclamps, or by a simple elastic tourniquet, the openings aremade in the viscera just sufficiently large to admit theseparate
. Diseases of the gall-bladder and bile-ducts, including gall-stones . Fig. 50.—Diagram to show Application of Serous Suture in theBone Bobbin Operation. it is dissolved, and the mucous and serous sutures effectuallyprotect the channel from leakage. If the Murphy button be used, the smallest size is selected,and two running sutures are applied, as shown in the the gall-bladder has been emptied, and the bowelclamped either by Murphys intestinal clamps or Lanesclamps, or by a simple elastic tourniquet, the openings aremade in the viscera just sufficiently large to admit theseparate ends of the button. The threads are then drawn onand tied around the central barrel of the button (Figs. 51 GALL-STONES, OR CHOLELITHIASIS 287 and 52), after which the two ends of the button are ap-proximated and pushed home firmly. The anastomosis isthen complete. The whole process occupies a very short time, and is reallyvery simple. It is, however, necessary to bear in mind thatthe button has to separate, by causing the approximated. 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 colon.
Size: 1421px × 1757px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, bookpublishernewyorkwilliamwood
