The fundus is walled off with gauze before the evacuation of its contents. An incision is made just through the serosa of the bulging fundus (Figure 2). A trocar is inserted to remove the liquid contents (Figure 3). Suction is maintained adjacent to the incision in the fundus as the trocar is withdrawn. A culture is taken routinely. The edematous wall is then grasped with Babcock forceps, and the opening is extended (Figure 4). A purse-string suture of fine absorbable material is placed about the opening in the fundus to control oozing and to close the fundus about the drainage tube. Any liquid or grumose material remaining in the lumen of the gallbladder is removed by suction. Since there is usually an impacted stone in the ampulla of the cystic duct, a determined effort is made to remove it to permit the escape of bile from the biliary ducts. A small, flexible scoop, such as a Cushing pituitary curet, is directed down to the ampulla (Figure 5). If the scoop cannot dislodge the stones, a fenestrated forceps is used. The lumen of the gallbladder is repeatedly flooded with saline. A small rubber catheter is inserted and anchored with an interrupted silk suture (Figures 6 and 7), or a Foley catheter may be used. The previously placed purse-string suture is tied snugly about the drainage tube (Figure 7). If the inflammation is severe, or if an abscess was encountered, or if there has been soiling about the wall, a rubber tissue drain is inserted along the wall of the gallbladder. The common duct must be decompressed if suppurative cholangitis is suspected.