# Revision Roux en Y, choledochoduodenostomy



## Callieb (Jul 11, 2012)

I really need help with this one!! It's complicated so I'm giving you the op note.
I'm not sure about the revision. 47760, 47780?

The peritoneal cavity entered and full length incision opened with cautery. Multiple dense adhesion identified in abdominal cavity. General lysis of adhesions carried out freeing up majority of small bowel.  We identified a jejunal-ileal anastomosis approx. 6cm from ileocecal valve in side to side fashion. Roux limb traced from gastrojejunostomy to implantation of jejunum 2.5 ft in length, somewhat redundant. Anastomosis from ligament of treitz to jenunum also redundant, approx 1.5ft in length. At this point decided to revise her roux y limb.
The jejunum was divided thru a rent in mesentery approx. 6 in. from lig of treitz for reimplantation of small bowel. This section also divided at jejunojejunostomy at previous roux y limb site using GIA-55 stapling device. The roux y limb in this section was also divided transversely and this short, approx 1ft, segment was inserted at previous roux y implant site by creating 2 anastomosis proximally and distally.  At this point, 6 in. from lig of treitz new roux y limb was reimplanted into the roux limb going up to the gastric remnant approx 1 ft from gastrojejunostomy.  This was done end to side fashion. Adequate anastomosis was obtained. This created an additional 2 to 2.5 ft of functional jejunal length. The bowel was returned to abdominal cavity and then turned attention to common bile duct. Duodenum kocherized and duodenal stump freed up.Stay sutures placed and incisiion made in distal bile duct above duodenum. Choledochoscopy done. Then created a choledochoduodenostomoy. Incision made in duodenum above bile duct approx 1cm in length.Back row of 4-0 PDS placed in running fashion and anterior row ofPDS placed in interrupted fashion with ea. lateral suture secured to itself Adequate anastomosis was attained.


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