File:Interstate medical journal (1917) (14597092449).jpg

Identifier: interstatemedica2419unse (find matches)
Title: Interstate medical journal
Year: 1917 (1910s)
Authors:
Subjects: Medicine
Publisher: St. Louis, : Interstate Medical Journal
Contributing Library: The College of Physicians of Philadelphia Historical Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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my (ranging from 0.5 to 3 percent). It will be seen that most of these forty-five experienced men con-sider cholecystectomy a better operation than cholecystostomy—that its chief indications are any disease of the gallbladder wallitself or any injury to the cystic duct. It will also be seen thatthere are distinct conditions which demand drainage and not re- 770 INTERSTATE MEDICAL JOURNAL moval, also that, in the opinion of the majority, acute empyema isbest treated by primary drainage and removal later. The mortalityin the hands of these experts was higher for cholecystectomy thanfor cholecystostomy. Cholecystectomy is an operation, attended, I believe, with manymore technical difficulties and dangers than simple drainage, andI regard it as a much more formidable one. Even in spite of goodanesthesia, good assistance, the Bevan incision, good exposure can-not always be had, and the operation cannot be as safe as drainageif there is poor exposure (Fig. 1). The operative dangers, aside
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Fig. 7.—Purse string suture (first row) in the closure of gallbladder. from shock are hemorrhage from the cystic artery, hemorrhagefrom the cut liver surface, requiring packs, and injury to the com-mon or hepatic ducts. Hemorrhage from the cystic artery may occur at the time ofoperation, or, later, from slipping of a ligature. Injury to the ductmay be caused by clamping off the duct too close to the commonduct, or by not appreciating the fact that the cystic duct often-times lies well up underneath the infundibulum or pelvis of the Guthrie: Cholecystectomy 771 gallbladder, and that the common duct may lie directly beneath thepelvis (Fig. 5). As emphasized by Mayo and Judd, the folds of the gastrohepaticomentum should be split, the infundibulum of the gallbladder shouldbe lifted up (Fig. 2) and separated from it by a dry gauze dis-sector, as advised by Mayo, or clamped by forceps, as advised byDeaver, to expose the cystic duct. It should be freed completelybefore it is clamped and cu

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