. Manuel de chirurgie opératoire. Fig. (Judd, Annales de chirurgie.) Le canal cystique de guide exposer sa jonction avec le canal commun. Ducou de la vésicule biliaire et la partie la plus basse du corps de la vésicule-bladderfrequently se trouvent le long du canal cystique, afin que lorsqu'il s'agit d'intervention réaliséeet disséqués tiré, le canal cystique est facilement séparé de la surface du foie(Fig. 702). L'étape 4. Isoler le canal cystique et l'artère cystique ensemble environ ^ou je pouce et doublement bien serrer ensemble. Fossé entre les colliers. L'étape 5.-faire de traction sur le forceps appliqué à le canal cystique besidethe gal

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. Manual of operative surgery. Fig. (Judd, Annals of Surgery.) the cystic duct as a guide expose its junction with the common duct. Theneck of the gall-bladder and the lowest part of the body of the gall-bladderfrequently lie along side the cystic duct, so that when this is dissected outand pulled up, the cystic duct is easily separated from the surface of the liver(Fig. 702). Step 4.—Isolate the cystic duct and the cystic artery together for about ^or I inch and doubly clamp them together. Divide between the clamps. Step 5.—Make traction on the forceps applied to the cystic duct besidethe gall-bladder and so make prominent the peritoneal folds attaching the CHOLECYSTECTOMY 573 bladder to the liver as well as the communicating vessels which are now easilycontrolled. Dissect the gall-bladder from the liver, leaving however enough ofits fundus attached so that it can be used as a tractor during the next step of theoperation (Fig. 703).. Fig. ?]o^.—{Jud(l, Annals oj Surgery.) Step 6.—^Ligate the Stump. This can be done without tension and withoutdanger to the common duct because of the thorough dissection. Suture thecut edges of the peritoneal folds from beside the stump up to the edge of theliver, removing the gall-bladder little by little as the sutures are being inserted.Place a small cigarette drain or roll of rubber dam down to the stump of thecystic duct and along the fissure from which the gall-bladder was removed(Fig. 704). 5 74 OPERATIONS ON THE BILIARY PASSAGES Cholecystenterostomy.—When the common duct is irreparably occluded, e.g., by malignant disease, or when it is desirable to drain the ducts in chronicpancreatitis, the formation of a fistula between the gall-bladder and the gutpermits the escape of bile. This operation is cholecystenterostomy. (A) Antero-colic method. When possible, it is best to unite the gall-bladderto the duodenum but under stress of circumstances that portion of the intestin

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