. Manual of operative surgery. 5^4 OPERATIONS ON THE BILIARY PASSAGES cystic and common ducts quite close to the surface. As the gall-bladderis usually strong enough, let the assistant take hold of it with his fingers orforceps and by gentle traction keep the parts well exposed, while at the sametime he protects and retracts, with a sponge in his left hand, the left side ofthe wound and the viscera, which would otherwise obstruct the view. Itwill now be observed that instead of the gall-bladder and cystic duct makinga considerable angle with the common duct, an almost straight passage isfound
. Manual of operative surgery. 5^4 OPERATIONS ON THE BILIARY PASSAGES cystic and common ducts quite close to the surface. As the gall-bladderis usually strong enough, let the assistant take hold of it with his fingers orforceps and by gentle traction keep the parts well exposed, while at the sametime he protects and retracts, with a sponge in his left hand, the left side ofthe wound and the viscera, which would otherwise obstruct the view. Itwill now be observed that instead of the gall-bladder and cystic duct makinga considerable angle with the common duct, an almost straight passage isfound from the fundus of the gall-bladder to the entrance of the bile-ductinto the duodenum, and if adhesions have been thoroughly separated, the sur- rectus irlocAHv . s^rui. | fxcoJ-lru:^ 51vertical p^aâ¢akrcmrAlina^wn. In Anterior. Fig. 694.â{Gray, by permission from the British Journal of Surgery.) geon has immediately under his eye the whole length of the ducts with thehead of the pancreas and the duodenum. (Robson, Brit. Med. Jour.,January 24, 1903.) Method C.âBevans incision: Bevan criticizes the vertical incision in theright semilunar line as being insufficient, and when long, objectionable becauseof nerve destruction; a T-shaped incision is difficult to close and is liable to leadto hernia; median incision does not give free access to the gall-bladder. Headvocates the following method (Annals of Surgery, xxx, 17): Make avertical incision along the outer border of the right rectus muscle or betweenits outer fibres. This suffices for the exploration or the completion of a simple EXPOSURE GALL-BLADDER 565 cystostomy. If it seems necessary to expose or work on the ducts, enlargethe incision by continuing its upper end obliquely upwards and inwards, itslower end obliquely downwards and outwards. Method D.â
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