elainehopf
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need thoughts on the following :
PREOPERATIVE DIAGNOSIS: Continent pouch stones.
POSTOPERATIVE DIAGNOSIS: Continent pouch stones.
PROCEDURE PERFORMED:
1. Laparotomy with open cystolitholapaxy in the Indiana pouch.
2. Placement of cystostomy tube in the continent pouch.
FINDINGS: Six stones ranging in size from 2 cm to 6 cm. These were all
removed. A 20-French tube was placed into the Indiana pouch.
INDICATION FOR PROCEDURE: found to have very large bladder stones that had difficulty catheterizing.
He was treated with appropriate antibiotics and selected to undergo open
stone extraction.
PROCEDURE IN DETAIL: The patient was brought to the Operating Room on
March 16, 2015. Preoperative antibiotics were given. Once the airway was
secured and sufficient anesthesia was achieved, his abdomen was prepped and
draped in sterile usual fashion. We placed a 12-French catheter into his
catheterizable stoma. We made a 5 cm incision at the level of the 11th rib
lateral to the continent stoma. Electrocautery was used to carry
dissection down to the level of the fascia. The fascia was opened and we
instilled blue dye irrigation into the pouch and this was identified with a
finder needle. We then opened the Indiana pouch after placing stay
sutures. We extracted the stones. There were 6 stones ranging in size
from 2 cm to 6 cm. The stones were removed in their entirety and 1 stone
was sent for culture. We then irrigated copiously. We then placed a 20-
French Foley catheter through the abdominal wall and placed a drainage tube in
the lateral area of the Indiana pouch. We then placed the catheter into the
Indiana pouch and inflated the balloon with 20 mL and tied a purse-string down.
We then closed the Indiana pouch using 3-0 Vicryl in 2 layers. We extended
the Indiana pouch using irrigation with no evidence of extravasation. It was
irrigated copiously once again and we closed the fascia using #1 Maxon in a
running fashion. The subcuticular fat was
reapproximated using 3-0 Vicryl and the skin was closed using 4-0 Monocryl.
The patient tolerated the procedure well, was extubated in the operating
room and brought to recovery room in stable condition.
I was present and participated in all aspects of the case.
Im thinking 50060 ...![Eek! :eek: :eek:](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
PREOPERATIVE DIAGNOSIS: Continent pouch stones.
POSTOPERATIVE DIAGNOSIS: Continent pouch stones.
PROCEDURE PERFORMED:
1. Laparotomy with open cystolitholapaxy in the Indiana pouch.
2. Placement of cystostomy tube in the continent pouch.
FINDINGS: Six stones ranging in size from 2 cm to 6 cm. These were all
removed. A 20-French tube was placed into the Indiana pouch.
INDICATION FOR PROCEDURE: found to have very large bladder stones that had difficulty catheterizing.
He was treated with appropriate antibiotics and selected to undergo open
stone extraction.
PROCEDURE IN DETAIL: The patient was brought to the Operating Room on
March 16, 2015. Preoperative antibiotics were given. Once the airway was
secured and sufficient anesthesia was achieved, his abdomen was prepped and
draped in sterile usual fashion. We placed a 12-French catheter into his
catheterizable stoma. We made a 5 cm incision at the level of the 11th rib
lateral to the continent stoma. Electrocautery was used to carry
dissection down to the level of the fascia. The fascia was opened and we
instilled blue dye irrigation into the pouch and this was identified with a
finder needle. We then opened the Indiana pouch after placing stay
sutures. We extracted the stones. There were 6 stones ranging in size
from 2 cm to 6 cm. The stones were removed in their entirety and 1 stone
was sent for culture. We then irrigated copiously. We then placed a 20-
French Foley catheter through the abdominal wall and placed a drainage tube in
the lateral area of the Indiana pouch. We then placed the catheter into the
Indiana pouch and inflated the balloon with 20 mL and tied a purse-string down.
We then closed the Indiana pouch using 3-0 Vicryl in 2 layers. We extended
the Indiana pouch using irrigation with no evidence of extravasation. It was
irrigated copiously once again and we closed the fascia using #1 Maxon in a
running fashion. The subcuticular fat was
reapproximated using 3-0 Vicryl and the skin was closed using 4-0 Monocryl.
The patient tolerated the procedure well, was extubated in the operating
room and brought to recovery room in stable condition.
I was present and participated in all aspects of the case.
Im thinking 50060 ...