Surgery of The Alimentary Tract Volume OnePDF电子书下载

Chapter 1 THE ESOPHAGUS 1

ANATOMY 1

PHYSIOLOGY 10

ANESTHESIA FOR OPERATIONS ON THE ESOPHAGUS 11

INCISIONS 11

SPECIAL PRINCIPLES OF ESOPHAGEAL SURGERY 13

ESOPHAGOSCOPY 14

ESOPHAGOTOMY 19

ESOPHAGOSTOMY 22

PERFORATIONS OF THE ESOPHAGUS 22

Suture of Perforation 26

Cervical Mediastinotomy 26

Posteroinferior Mediastinotomy 28

BENIGN STRICTURES OF THE ESOPHAGUS 30

Congenital Strictures of the Esophagus 30

Acquired Benign Stenosis of the Esophagus 32

Corrosive Strictures of the Esophagus 32

Postsurgical Strictures of the Esophagus 37

Inflammatory Strictures of the Esophagus 37

Operative Treatment 39

Esophagoplasty (Heineke-Mikulicz) 39

Partial Esophagectomy with End-to-End Esophago-esophagostomy 39

Partial Gastrectomy for Esophagitis with Stricture 41

RECONSTRUCTION OF THE ESOPHAGUS 42

Intrathoracic Replacement of the Esophagus 42

Extrathoracic Esophagoplasty 42

Roux＇s Method (Esophagojejunogastrostomy) 44

Herzen＇s Method 47

Wullstein＇s Method 50

Birger＇s Method 52

Esser＇s Method 53

Lexer＇s Method 54

Ochsner-Owens Modification of Lexer＇s Method 58

Other Methods 62

BENIGN TUMORS OF THE ESOPHAGUS 62

Local Excision of Benign Tumors 64

ESOPHAGEAL ACHALASIA 65

Bougienage 68

Operative Treatment 70

Side-to-Side Esophagogastric Anastomosis (Heyrovski) 70

Side-to-Side Esophagogastrostomy (Grondahl) 73

Cardioplasty (Wendel) 74

Cardioplasty (Girard) 75

Esophagocardiomyotomy (Heller) 76

Partial Esophagectomy with Esophagogastrostomy (Rumpel,Wangensteen) 79

Other Procedures for the Treatment of Achalasia 80

TRACHEOESOPHAGEAL AND BRONCHOESOPHAGEAL FISTULAS 80

Congenital Esophageal Atresia with or without Tracheoesophageal or Bronchoesophageal Fistula 81

Extrapleural Operation (One Stage) 83

One-Stage Intrapleural Operation 88

Two-Stage Intrapleural Operation 90

Acquired Esophagorespiratory Fistula 93

Repair of Acquired Esophagorespiratory Fistula 94

ESOPHAGOPLEURAL FISTULA 97

Repair of Esophagopleural Fistula 98

ESOPHAGEAL VARICES 99

Tamponade 102

Injection Treatment 105

Ligation of the Hepatic,Splenic and Left Gastric Arteries (Rienhoff) 106

Splenic Artery Ligation (Blain) 109

Gauze Packing of Mediastinum (Garlock) 111

Transesophageal Ligation of Bleeding Varices (Crile) 114

Other Operations for Esophageal Varices 116

ESOPHAGEAL DIVERTICULA 117

Pharyngoesophageal Diverticula 117

Two-Stage Diverticulectomy (Lahey) 121

One-Stage Diverticulectomy 126

Supradiaphragmatic Diverticula 130

Supradiaphragmatic Diverticulectomy 131

Supradiaphragmatic Diverticular Suspension 131

Midesophageal Diverticula 132

MALIGNANT TUMORS OF THE ESOPHAGUS 133

Souttar＇s Intubation 135

Esophagectomy 137

Partial Esophagectomy with End-to-End Esophago-esophagostomy 137

Cervical Esophagectomy with Skin Flap Closure in Two Stages (Wookey) 138

Cervical Esophagectomy and laryngectomy with Skin Flap Closure in Two Stages (Wookey) 143

Cervical Esophagectomy with Replacement by Tubed Pedicled Grafts (Bricker) 144

One-Stage Partial Esophagectomy with Replacement by a Plastic Tube (Berman) 149

Partial Esophagectomy with Low Esophagogastrostomy (Sweet) 154

partial Esophagectomy with High Intrathoracic Esophagogastrostomy (Sweet) 163

Partial Esophagectomy with Cervical Esophagogastrostomy (Sweet) 166

Partial Esophagectomy with Cervical Esophagojejunostomy in One Stage (Sweet) 170

One-Stage Total Esophagectomy with Esophagogastrostomy (Shefts and Fischer) 171

Two-Stage Intrathoracic Esophagojejunostomy (Rienhoff) 174

Artificial Esophagus Formed by a Free Segment of Intestine Covered by Skin (Longmire and Ravitch) 181

Intrathoracic Replacement of Esophagus with Transverse and Descending Colon 185

Repair of Tracheobronchial Defects Produced during Esophagectomy 185

Repair of Small Defects by Patching 186

Repair of Larger Tracheobronchial Defects 186

Repair with Tantalum Mesh Covered by Cutis Graft (Handelsman-Kieffer-Edgerton) 187

Repair by Dermal Skin Grafts Laced with Wire (Gebauer) 188

Repair with Wire Coil Covered by Fascia (Belsey) 190

Repair with Viable Pedicle Graft (Penton and Brantigan) 191

TRACHEOTOMY 192

REFERENCES 197

Chapter 2 THE STOMACH AND DUODENUM 201

SURGICAL ANATOMY OF THE STOMACH 201

SURGICAL ANATOMY OF THE DUODENUM 207

PHYSIOLOGY OF THE STOMACH 210

PHYSIOLOGY OF THE DUODENUM 212

GASTRIC,GASTRODUODENAL AND LOWER GASTROINTESTINAL INTUBATION 212

Peroral Gastric Intubation 212

Nasal Gastric,Gastroduodenal and Lower Gastrointestinal Intubation 214

Levin Tube 214

Bilumen Gastrojejunostomy Tube 216

Bilumen Gastroduodenal Tube 216

Miller-Abbott Tube 217

Harris and Cantor Single-Lumen Mercury-Weighted Tubes 219

Comment on Use of Indwelling Gastrointestinal Tubes 220

PERORAL GASTROSCOPY 221

Peroral Gastroscopy with flexible Gastroscope 222

Peroral Gastroscopy with Rigid-Tube Gastroscope (Jackson) 224

ANTERIOR GASTROSCOPY AND DUODENOSCOPY THROUGH A GASTROTOMY OR GASTROSTOMY STOMA 227

ACUTE DILATATION OF THE STOMACH 227

GASTROLYSIS AND DUODENOLYSIS (FREEING OF ADHESIONS) 228

VOLVULUS OF THE STOMACH 229

GASTROPEXY 231

GASTRIC PLICATION 234

GASTROINTESTINAL SUTURING 235

Interrupted Lembert Suture 238

Continuous Lembert Suture 240

Halsted Interrupted Quilt (Mattress) Suture 240

Purse-String Suture 240

Cushing Suture 242

Connell Suture 242

Parker-Kerr Stitch 242

Through-and-Through U-Stitch 243

Marshall U-Stitch 245

Furrier Suture 248

Simple Overhand continuous or Interrupted Suture (Albert) 248

Lock-Stitch (Glover Stitch) 248

Czerny Interrupted Sutures 249

Enterorrhaphy by a combination of a Continuous Through-and-Through Marginal (Albert) Suture and Interrupted,Gould Inverted Mattress Suture 250

Three-Layer Suture Line 251

Suture Instrument of de Petz 251

Murphy Button 253

INCISIONS FOR EXPOSURE OF STOMACH AND DUODENUM 254

GASTROTOMY 256

GASTRORRHAPHY 258

INCISED AND GUNSHOT WOUNDS OF THE STOMACH 261

GASTROSTOMY 264

Witzel Gastrostomy 265

Intramural Gastrostomy (Submucosal Canal) (Marwedel-Soresi- Partipilo Method) 267

Superimposed Pruse-String Gastrostomy (Stamm-Senn Method) 269

Brunschwig＇s Gastrostomy 270

Kader (Double Linear Plication) Gastrostomy 270

Ssabanajew-Franck (Stomach Cone Transfer) Gastrostomy 272

Kocher＇s Modification of the Ssabanajew-Franck Operation 275

Albert＇s Modification of the Ssabanajew-Franck Operation 275

Hahn＇s Modification of the Ssabanajew-Franck Operation 275

Glassman＇s Gastrostomy 276

Janeway-Depage (Tubular) Gastrostomy 277

Spivack Valvular Modification of Janeway-Depage Tubular Gastrostomy 280

Comment on Janeway-Type Gastrostomies 280

Beck-Jianu (Long Gastric Tube) Gastrostomy 281

Retrograde Bougienage of the Esophagus through a Gastrostomy Opening 284

Comment on Gastrostomies in General 285

OPERATIONS FOR STENOSIS OF THE CARDIA 285

Retrograde Stretching of the Cardiac Orifice from within the Stomach 286

Other Procedures 286

SIMPLE EXCISION OF A PEPTIC ULCER 286

Excision of Ulcer on Anterior Wall of Stomach 286

Excision of Ulcer on Posterior Wall of Stomach 286

Retrogastric Excision 286

Transgastric Excision 287

Cautery Excision of Gastric Ulcer (Balfour) 288

Wedge-Shaped Excision of Ulcer on Lesser Curvature of Stomach with or without Accompanying Gastrojejunostomy 289

Simple Excision of Small Ulcer on Anterior Wall of the First Portion of Duodenum 291

LOCAL EXCISION OF BENIGN GASTRIC TUMOR (INCLUDING POLYPS) 291

DIVERTICULUM OF THE SHTOMACH 291

Excision of Gastric Diverticulum 293

DEVERTICULUM OF THE DUODENUM 293

Excision of Duodenal Diverticulum 294

DUODENOJEJUNOSTOMY 297

OPERATIONS UPON THE PYLORUS FOR ENLARGING ITS ORIFICE 301

Pylorotomy 301

Pyloric Hypertrophy in Adults 301

Congenital Hypertrophic Pyloric Stenosis 302

Fredet-Ramstedt Pylorotomy 302

Pylorodiosis 307

Pyloroplasty 307

Heineke-Mikulicz Pyloroplasty 307

Horsey Modification of Heineke-Mikulicz Pyloroplasty 309

Finney U-Shaped Pyloroplasty (Gastroduodenostomy) 309

Balfour＇s Excision Pyloroplasty 314

Pyloroplasty with Excision of Ulcer (Judd) 316

Comment on Pyloroplasty in General 316

GASTRCENTEROSTOMY 317

Gastroduodenostomy (Jaboulay,1892) 317

Gastroduodenostomy (Rienhoff) 319

Gastrojejunostomy 323

Precolic (Antecolic) Anterior Gastrojejunostomy (Woelfler,1881) 325

Precolic Posterior Gastrojejunostomy 332

Retrocolic Posterior Gastrojejunostomy (Von Hacker,1885) 332

Retrocolic Anterior Gastrojejunostomy 340

Roux-en-Y Gastrojejunostomy 341

Comments on Gastrojejunostomy in General 343

METHODS OF CLOSURE OF DUODENAL STUMP IN GASTRECTOMY OR EXCLUSION OPERATIONS 344

Inversion by Parker-Kerr Suturing 345

Rienhoff Method 346

Closure with Tamponade 346

Closure by Multiple Purse-String Sutures 348

Closure with Ligature and Suture 350

Temporary Duodenostomy 350

GASTRIC AND DUODENAL (PEPTIC) ULCER 351

Complications of Peptic Ulcer 358

Perforation 358

Obstruction 359

Bilocular Stomach or Hour-Glass Contraction of Stomach 360

Hemorrhage 360

Treatment of Peptic Ulcer 363

TUMORS OF THE STOMACH AND DUODENUM 365

Benign Tumors 365

Benign Gastric Tumors 365

Benign Tumors of the Duodenum 367

Symptoms and Diagnosis of Benign Tumors of Stomach and Duodenum 367

Treatment of Benign Tumors of Stomach and Duodenum 367

Malignant Tumors 368

Malignant Tumors of the Stomach 368

Malignant Tumors of the Duodenum 369

Symptoms and Diagnosis of Malignant Tumors of Stomach and Duodenum 370

Treatment of Malignant Tumors of Stomach and Duodenum 371

GASTRECTOMY 371

Partial Gastrectomy 375

Partial Gastrectomy with End-to-End Gastroduodenostomy (Billroth Ⅰ Operation) 389

Von Haberer Modification of the Billroth Ⅰ Operation 400

Horsley Modification of the Billroth Ⅰ Operation 404

Kocher Modification of the Billroth ⅠOperation 404

Von Haberer-Finney Modification of the BillrothⅠOperation 404

Tubular of Staircase Modification of Billroth Ⅰ Partial Gastrectomy with a Variety of Methods of Performing the Accompanying Gastroduodenostomy 406

Comment on Billroth Ⅰ Procedure 409

Partial Gastrectomy of the Median Portion of the Stomach (Sleeve Resection) 409

Segmental Partial Gastrectomy for Peptic Ulcer (Wangensteen) 410

Transthoracic Resection of Esophagus and Cardiac End of Stomach 413

Comments on Billroth Ⅱ partial Gastrectomy 416

Polya Modification of Billroth Ⅱ Operation 417

Polya-Balfour Modification of Billroth Ⅱ Operation 433

Hofmeister Modification of Billroth Ⅱ Operation 433

Original Billroth Ⅱ Partial Gastrectomy 440

Devine Exclusion Two-Stage Partial Gastrectomy 443

Finsterer Partial Gastrectomy with Antral Exclusion of Peptic Ulcer 447

Roux-en-Y Modification of Billroth Ⅱ Operation 450

Results of Partial Gastrectomy 452

Total Gastrectomy 454

Longmire Method 456

Lahey Method 462

Orr Method 469

Graham Method 471

Roux-en-Y Total Gastrectomy 472

Total Gastrectomy with Esophagoduodenostomy 481

Total Gastrectomy with Formation of Substitute Gastric Reservoir 482

Results of Total Gastrectomy 486

Comments on Partial and Total Gastrectomies 486

OPERATIONS FOR PYLORODUODENAL OCCLUSION AND EXCLUSION AND FOR ANTRAL EXCLUSION 489

Pyloroduodenal Occlusion by Ligation of the Pylorus,Accompanied by Gastrojejunostomy 490

Prepyloric Occlusion by Transverse Plication 490

Pyloroduodenal Exclusion by Disconnection (Bier) 490

Prepyloric Exclusion by Disconnection (Von Eiselberg) 490

Devine Operation for Prepyloric Exclusion 490

OPERATIONS FOR HOUR-GLASS OR SADDLE-BAG DEFORMITY OF THE STOMACH 494

Lateral Gastrogastrostomy for Hour-Glass Stomach 494

Kammerer-Finney Gastroplasty for Hour-Glass Stomach 494

Heineke-Mikulicz Gastroplasty for Hour-Glass Stomach 494

Wedge-Shaped Excision for Hour-Glass Stomach 494

Sleeve Resection for Hour-Glass Stomach 496

Operation for Hour-Glass Stomach by Anterior or Posterior Gastrojejunostomy with the Proximal Pouch 497

COMPLICATIONS AFTER GASTROINTESTINAL ANASTOMOSIS 498

Hematemesis 498

Postoperative Gastric Retention 500

Jejunoplasty 502

Leakage form Duodenal Stump 508

Rupture of Abdominal Incision 509

Venous Thrombosis 509

Marginal Jejunal Ulcer 510

Disconnection of Gastrojejunostomy 511

Repair of Gastroileostomy 514

Gastrojejunocolic Fistula 515

Pfeiffer Method of Closing Gastrojejunocolic Fistula 516

Findlay Method of Closing Gastrojejunocolic Fistula 520

Marshall Method of closing Gastrojejunocolic Fistula 523

Gastric Fistula 525

External Gastric Fistula 525

Internal Gastric Fistula 526

Duodenal Fistula 527

Internal Duodenal Fistula 527

External Duodenal Fistula 529

Other Complications 532

OPERATIONS FOR ACUTE COMPLICATIONS OF GASTRIC AND DUODENAL ULCERS 533

Hemorrhage from Ulcers of the Stomach and Duodenum 533

Perforated Peptic Ulcer 541

Closure of Acutely Perforated Peptic Ulcer 545

Nonoperative Treatment of Perforated Peptic Ulcer 548

VAGOTOMY 549

Abdominal (Subdiaphragmatic) Vagotomy 553

Transthoracic (Supradiaphragmatic) Vagotomy 556

Postoperative Complications of Vagotomy 559

Comments on Vagotomy 560

REFERENCES 561

Chapter 3 THE LIVER 565

ANATOMY 565

PHYSIOLOGY 570

LIVER FUNCTION TESTS 575

GENERAL SURGICAL CONSIDERATIONS 584

ANESTHESIA 587

INCISIONS 587

Incisions Used for Transperitoneal Exposure of Anterosuperior Surface of Liver 587

Transperitoneal Exposure of Dome and Anterior Aspect of Right Lobe 588

Transperitoneal Exposure of Lower Lateral Border of Right Lobe 588

Extraperitoneal-Extrapleural Exposure of Extraperitoneal Surface of the Liver 588

Intercostal Subpleural Exposure of Superior Surface 589

Rib Resection for Extrapleural Exposure of Superior Surface 589

Transpleural Approach to the Superior Surface Following Partial Resection of Ribs 589

EXPLORATORY AND DIAGNOSTIC OPERATIONS UPON THE LIVER 589

Exploratory Puncture without Incision of the Chest or Abdominal Wall 589

Needle Biopsy 591

Peritoneoscopy 593

WOUNDS OF THE LIVER 603

PARTIAL HEPATECTOMY FOR REMOVAL OF TUMOR OF THE LIVER 607

V-Shaped Excision of Small Tumor of Edge of Liver 608

V-Shaped Excision of Large Tumor of Anterior Margin 608

Left Lobectomy of the Liver 609

INTRAHEPATIC ABSCESS 612

Pyogenic Intrahepatic Abscess 612

Amebic Intrahepatic Abscess 616

Aspiration of Intrahepatic Abscess 620

Closed Tube Drainage of Amebic Abscess of the Liver 622

Hepatotomy for Intrahepatic Abscess 623

One-Stage Transperitoneal Hepatotomy for Intrahepatic Abscess 624

Two-Stage Transperitoneal Hepatotomy for Intrahepatic Abscess 626

Transthoracic Hepatotomy 626

SUBPHRENIC (SUBDIAPHRAGMATIC) ABSCESS 632

Anterior Extraserous Drainage of Subphrenic or Intrahepatic Abscess (Clairmont) 638

Posterior Extraserous Drainage of Subphrenic or Intrahepatic Abscess (Nather and Ochsner) 639

Comment 642

HYDATID DISEASE 642

Hydatid Cysts of the Liver 651

Surgical Treatment of Uncomplicated Cysts 651

Treatment of Complicated Cysts 655

Postoperative Complications 659

Results of Surgical Treatment 660

Hydatid Cysts of the Peritoneum and Pelvis 660

Hydatid Cysts in Other Locations 662

NONPARASITIC CYSTS OF THE LIVER 663

CIRRHOSIS OF THE LIVER 664

Abdominal Paracentesis for Evacuation of Ascitic Fluid 670

Crosby-Cooney-Lord (＂Button＂) Operation for Intractable Ascites 672

Establishment of New Intraperitoneal Venous Channels in Cirrhosis of the Liver (Talma-Drummond-Morison Operation) 674

Extraperitoneal Omentopexy in Cirrhosis of the Liver 675

Portacaval Anastomoses 676

Splenorenal Anastomosis 679

Anastomosis of Portal Vein to Vena Cava 683

Comments on Portacaval Anastomoses 687

Splenic Artery Ligation 688

TREATMENT OF WOUNDS OF THE HEPATIC ARTERY AND PORTAL VEIN INCURRED DURING OPERATION 689

REFERENCES 690

Chapter 4 THE GALLBLADDER AND EXTRAHEPATIC BILIARY DUCTS 693

SURGICAL ANATOMY OF THE GALLBLADDER 693

SURGICAL ANATOMY OF THE EXTRAHEPATIC BILIARY DUCTS 696

PHYSIOLOGY 700

ANOMALIES AND CONGENITAL ABNORMALITIES OF THE GALLBLADDER AND BILE DUCTS 702

Anomalies of the Gallbladder 703

Anomalies and Abnormalities of the Common bile Duct 708

Cystenterostomy 712

Congenital Atresia of the Bile Ducts 713

Operation for Atresia of the Bile Ducts 715

OBSTRUCTIVE JAUNDICE DUE TO INSPISSATED BILE OR MUCUS IN THE BILIARY PASSAGES OF INFANTS 719

Operation for Relief of Biliary Obstruction Due to Inspissated Bile or Mucus 719

CHOLECYSTITIS AND CHOLELITHIASIS 720

Acute Cholecystitis 721

Chronic Cholecystitis and Cholelithiasis 727

Cholelithiasis 730

Results of Surgical Treatment of Acute and Chronic Cholecystitis and Cholelithiasis 733

CHOLESTEROSIS OF THE GALLBLADDER 733

RECOGNITION OF CHRONIC CHOLECYSTIC DISEASE AT OPERATION 734

CHOLEDOCHOLITHIASIS 735

TUMORS OF THE EXTRAHEPATIC BILIARY TRACT 738

Benign Tumors of the Gallbladder 738

Primary Carcinoma of the Gallbladder 739

Primary Sarcoma of the Gallbladder 743

Benign Tumors of the Bile Ducts 743

Primary Malignant Tumors of the Extrahepatic bile Ducts 744

GENERAL SURGICAL CONSIDERATIONS OF OPERATIONS ON THE BILIARY TRACT 746

OPERATIONS UPON THE GALLBLADDER 752

Cholecystectomy 752

Total Cholecystectomy 756

Cholecystectomy with Drainage of the Common Duct 762

Partial Cholecystectomy with Chemical Destruction of the remaining Mucosa 762

Partial Cholecystectomy with Electrocoagulation of the Remaining Mucosa (Thorek) 765

Postoperative Care of Cholecystectomy Subjects 767

Cholecystostomy 768

Operations for Internal Drainage of the Gallbladder (Cholecystoduodenostomy,Cholecystogastrostomy,and Cholecystojejunostomy) 772

Cholecystoduodenostomy 773

Cholecystogastrostomy or Cholecystojejunostomy 775

Operations for Wounds of the Gallbladder 775

SECONDARY OPERATIONS FOR RECURRING BILIARY TRACT DISEASE 775

OPERATIONS UPON THE EXTRAHEPATIC BILE DUCTS 779

Supraduodenal Choledochostomy an Choledocholithotomy (Exploration of the Common Duct) 780

Transduodenal Ampullary Choledochoduodenostomy 794

Transduodenal Approach for Intraduodenal (Interstitial) Choledochotomy for Calculus 798

Retroduodenal Choledochotomy for Calculus Followed by Choled0chorrhaphy 799

Transduodenal Excision of the Duodenal Ampulla (of Vater) 801

Choledochoduodenostomy,Choledochogastrostomy and Choledochojejunostomy for Irremediable Obstruction in the Distal Portion of the Common Duct 802

Excision of the Gallbladder,Cystic Duct and the Junction of the Main Hepatic and Common Ducts for Tumor,Followed by Hepaticocholedochostomy over a T-Tube 806

Repair of Wounds of the Biliary Ducts 808

Repair of Wounds Due to Surgery 808

Repair of Wounds Due to Trauma 810

Repair of Benign Stricture of the Bile Duct 811

Incision and Repair of Stricture by Heineke-Mikulicz Method 817

Repair by Simple End-to-End Anastomosis 818

Repair by Dissecting out Retroduodenal Portion of Common Duct Followed by End-to-End Anastomosis 820

Repair by End-to-End Anastomosis of the Duct over Temporary Indwelling Tube Other than a T-Tube 824

Repair by End-to-End Anastomosis of Ducts without the Use of Either a Temporary or Permanently Indwelling Tube 827

Repair by End-to-End Anastomosis of the Ducts over a Permanent Indwelling Tube 828

Comment on Repair by End-to-End Anastomosis of the Ducts 829

Repair by Dilation and Tube Implantation of the Duct 830

Bridging Defects in bile Ducts by Tubes (Wilms-Sullivan) 830

Simple Excision of Stricture of the Bile Duct with Implantation of Proximal Segment of Duct into Intestinal Tract 832

Intrahepatic Cholangiojejunostomy with Partial Hepatectomy (Longmire) 841

Use of Pedicle Flap of Stomach (Hoag) 844

Use of Mucosal Flap of Jejunum (Cole) 845

Establishment of an External Biliary Fistula with Later Implantation of the Fistulous Tract into the Intestinal Tract 848

Formation of Temporary External Biliary Fistula 848

Cholecystenterostomy 850

Comments on Operations for Repair of Stricture of Bile Ducts 850

HEPATOSTOMY 852

Internal Hepatostomy 852

External Hepatostomy 853