Operative surgery of the gall tracts with original report of twenty successful cholecystenterostomies by means of the anastomosis button / by John B. Murphy.

  • John Benjamin Murphy
Date:
[1894], ©1894
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Licence: Public Domain Mark

Credit: Operative surgery of the gall tracts with original report of twenty successful cholecystenterostomies by means of the anastomosis button / by John B. Murphy. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    culiarities of the individual case will be the guide to the surgeon as to when it must be performed. III. Suture of the Gall Bladder with Secondary Incision, Chole- cystostoniy in Two Sittings.—The serous surface of the gall bladder is united to the margin of incision in the abdominal wall and a suf- ficient time is allowed to elapse for adhesions to take place, from five to fifteen days; then an incision is made in the gall bladder and its contents allowed to escape. The operation was first sug- gested by Carri, and executed by Blodgett and Kocher in 1878. Courvoisier collected thirty-two cases. Riedel operated in this manner thirty-four times, eleven of these are included in Courvoi- sier's report. I find in the literature from June, 1890, at which time Courvoisier's report was published, to February 28, 1893, but four cases, with the exception of those of Reidel, twenty-three cases, making a total of fifty-nine cases, with six deaths, or a mor- tality of ten per cent. Of the patients that left the hospital, about thirty-four per cent were discharged with a fistula; these had an average treatment of two and one-half months. Riedel has cham- pioned this operation from the beginning and has persistently adhered to it while other surgeons have taken up the operation of one sitting, as shown by the statistics, only four operations of this kind being reported since June, 1890. Bardenheuer, Langenbuch, Mikulicz and Lauenstein have been strong advocates of this ope- ration in the order mentioned, but have all deserted it, notwith- standing its favorable statistics, leaving Riedel alone its great advocate. The indications for this operation are the same as for cholecystostomy of one sitting, to be mentioned hereafter. IV. Cholecystostomy in One Sitting, Suture with Immediate In- cision.—The first operation of this kind was performed on July 15, 1867, by Bobb, who was making a laparotomy on the diagnosis of ovarian tumor, this being the first laparotomy opening of the gall bladder and cholecystostomy of one sitting. Without a knowledge of this case, in the years 1878 and ]879, Marion Sims, W. W. Keen and Lawson Tait performed the same operation without previously diagnosticating the case. This operation was named by Lawson Tait ideal cholecystostomy. It would be more appropriately termed unnatural cholecystostomy, as it is not natural for the gall bladder to empty on the surface of the abdo- men. The term natural cholecystostomy should be reserved for the operation known as cholecystenterostomy, because the bowel is the natural receiver of the contents of the gall tracts. From that time there have been collected by Courvoisier 120 cases, by