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The surgeon of to-day who launches his bark on the sea of gall-stone surgery must be prepared for some trying experiences. Sir Spencer Wells has, in his teaching as to hepatic surgery, repeatedly directed attention to the importance of delicate manipulations. He has shown from his own experience how the gall-bladder and the common duct may—especially in cases of chronic calculous occupation and recurrences —take on a condition of friability compelling a supreme carefulness of handling. Even with a great deal of care the impaired structures may be lacerated at places and times most compromising to the surgeon's best results. The walls of the gall-bladder are frequently the seat of hypertrophy while the capacity is diminished; they tear and bleed readily and refuse to hold the suture, when the contrary actions are desirable. The walls of the ductus choledochus, on the other hand, often show a thinning and dilatation where
DIFFICULTIES ENCOUNTERED IN HEPATIC SURGERY FROM FRIABILITY OF CHOLEDOCHAL STRUCTURES. SOME RECENT ADVANCES AND IMPROVEMENTS.. JAMA. 1892;XVIII(1):14–16. doi:10.1001/jama.1892.02411050020007