# Revision of Gastrostomy tube



## herrera4 (May 14, 2014)

For some reason I feel like im reading the same sentence over and over again- I keep coming up with lap codes or open that don't seem to fit--any help is appreciated 

NOTE

On the day of surgery, she was brought into the Operating Room and placed in supine position on the Operating Room table. General endotracheal anesthesia was administered. The patient was hypotensive. Anesthesia resuscitated the patient. A midline incision was made from xiphoid down to pubis. The abdomen was entered under direct vision. Once the abdomen was entered, a large amount of air issued forth. The abdomen was entered. There was quite a bit of murky fluid. The entire abdomen was opened. There was some concern she could have had a colonic perforation so the pelvis was explored first. Other than gross contamination from G tube feeding and gastric contents, there was no pathology noted. The area was generously irrigated and suctioned free with large amount of warm saline. The left gutter and the right gutter were similarly explored and irrigated. The entire small bowel was investigated. There was no evidence of ischemia. There was no crepitus at the bowel wall. The G tube placement was actually lateral to the gastropexy so the gastropexy had to be taken down from the anterior abdominal wall. This was carefully done with electrocautery and Metzenbaum scissors. Once the gastropexy was freed up, the G tube was well visualized and it was actively leaking the G tube contents. This was clamped with an Allis clamp to control the leakage. The left upper quadrant was generously irrigated and suctioned free. The right upper quadrant similarly was irrigated and suctioned. The adhesions to the stomach to the omentum and anterior abdominal wall were taken down so that the stomach could be mobilized and the G tube could be revised. The G tube was divided exterior to the skin and it was slowly withdrawn from the stomach. Yankauer suction was placed into the stomach. A large amount of tube feeds was removed from the stomach. The stomach was then tacked to the anterior abdominal wall with 3-0 silk stitch. A 20 French G tube was brought to the field. A new gastrostomy site was made somewhat inferior to the previous G tube site. The G tube was advanced through the abdominal wall and into the stomach. A 3-0 Vicryl pursestring stitch was placed in the stomach and tied after the balloon was inflated in the G tube. Five stitches were used to tack the stomach to the anterior abdominal wall.  The sponge, instrument and needle counts were all correct. A 10 mm Jackson-Pratt drain was placed in the pelvis, brought out through left lower quadrant. The abdomen was closed with running looped PDS and the skin was closed with staples. The patient tolerated the procedure well. Because she continued to be tachycardic and she was going to return to the CCU, she was left intubated and brought to Recovery Room in stable condition.


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