drsbilling
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1. Exploratory laparotomy
2. Dissection of gastric remnant from aberrant bone growth into the tissues from xiphoid from previous surgery.
3. Lysis of adhesions
4. Takedown of jejunostomy gastric remnant to the jejunal anastmosis, jejunostomy and gastrostomy.
A midline incision was made from the xiphoid to below the umbilicus and deepened. Marked adhesions were present of the small bowel and the transverse colon; these were lysed. At this time, we could not see the gastric remnant because of dense adhesions envelopsing the area. The xiphoid bone was going into the tissues. This was gradually sahved with some of the bone rib to make sure we did not enter it. Finally, the small portion of the remaining stomach was seen. Further dissection was carried out, and the small pouch was dissected with great difficulty because of the dense adnshions and bony grown. The transverse colon was separated from this. Multiple bleeds were suture ligated and clipped. Dissection was very tedious. Finally the jejunostomy was taken down. The gastric remnant was then anastomosed to the jejunum in 2 layers using 000 silk outside and 3-0 Vicryl inside, running sutures and canal sutures on the outside. The 000 sutures of silk were also used, second layer. The NG tube was passed from the stomach into the duodenum. Distal to the anastomosis a jejunostomy was performed. Concentric 3-0 silk sutures were done, and a jejunostomy tube was inserted with the baloon. This was tacked down to the fascia with interrupted sutures of 3-0 silk. A gastrostomy tube was also put in the gastric remnant. Concentric 3-0 silks were put in. A size 20 gastrostomy tube was put in and tunneled towards the duodenum. It was anchored to the skin. The baloon was inflated and the exit site was repaired with3-0 silk interrupted sutures to the abdominal wall. The abdomen was lavaged copiously. It was closed with #2 Vicryl running interrupted sutures and skin with staples. All the tubes were anchored to the skin with 3-0 silk. A sterile dressing was applied.
2. Dissection of gastric remnant from aberrant bone growth into the tissues from xiphoid from previous surgery.
3. Lysis of adhesions
4. Takedown of jejunostomy gastric remnant to the jejunal anastmosis, jejunostomy and gastrostomy.
A midline incision was made from the xiphoid to below the umbilicus and deepened. Marked adhesions were present of the small bowel and the transverse colon; these were lysed. At this time, we could not see the gastric remnant because of dense adhesions envelopsing the area. The xiphoid bone was going into the tissues. This was gradually sahved with some of the bone rib to make sure we did not enter it. Finally, the small portion of the remaining stomach was seen. Further dissection was carried out, and the small pouch was dissected with great difficulty because of the dense adnshions and bony grown. The transverse colon was separated from this. Multiple bleeds were suture ligated and clipped. Dissection was very tedious. Finally the jejunostomy was taken down. The gastric remnant was then anastomosed to the jejunum in 2 layers using 000 silk outside and 3-0 Vicryl inside, running sutures and canal sutures on the outside. The 000 sutures of silk were also used, second layer. The NG tube was passed from the stomach into the duodenum. Distal to the anastomosis a jejunostomy was performed. Concentric 3-0 silk sutures were done, and a jejunostomy tube was inserted with the baloon. This was tacked down to the fascia with interrupted sutures of 3-0 silk. A gastrostomy tube was also put in the gastric remnant. Concentric 3-0 silks were put in. A size 20 gastrostomy tube was put in and tunneled towards the duodenum. It was anchored to the skin. The baloon was inflated and the exit site was repaired with3-0 silk interrupted sutures to the abdominal wall. The abdomen was lavaged copiously. It was closed with #2 Vicryl running interrupted sutures and skin with staples. All the tubes were anchored to the skin with 3-0 silk. A sterile dressing was applied.