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March 3, 1917


JAMA. 1917;LXVIII(9):706. doi:10.1001/jama.1917.04270030038013

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The difficulties experienced in the operation of cholecystectomy, with their consequent increase in the operative risk, are responsible to a considerable extent for the wide variance in opinion as to the advisability of its performance in place of chylecystotomy. The general adaptation of the Bevan curved or oblique incisions beginning above near the xiphoid, permitting of outward rotation of the liver with consequent exposure of the region of the ducts, has greatly improved the operative results. The removal of the gallbladder by starting at the cystic duct has become the routine procedure wherever possible in a great many clinics. Its chief advantage lies in the better hemostasis during the separation of the gallbladder from the liver, since the most troublesome bleeder, the cystic artery, is clamped, cut and ligated along with the cystic duct as the first step in the removal. The oozing which occurs from the surface of the

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