On certain occasions considerable difficulties arise during attempts to remove gallstones from the biliary tract. Calculi in the hepatic ducts found at the operation may tax the skill of a man with a wide experience in this type of work, not to speak of a general surgeon who encounters such conditions only once in a great while. W. Walters,1 of the Mayo Clinic, cited a case in which he was not able to explore the intrahepatic duct on account of a large, anomalous hepatic artery crossing the duct. Obesity of the patient may also interfere with exploration of the hepatic ducts. Inflammatory processes, edema and adhesions may further complicate the situation.
Some stones lodged in the common duct require a transduodenal approach or an extensive mobilization of the duodenum for exposure of the retroduodenal portion of the ductus choledochus. Both technical procedures, even in the hands of the more