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Preoperative Diagnosis: Gastric outlet obstruction secondary to cancer
Postoperative Diagnosis: Same
Procedure Performed: Laparoscopic gastrojejunostomy
Surgeon:
assistant surgeon:
Surgical Staff:
Anesthesia: General
Estimated Blood Loss: Minimal
Antibiotics: cefazolin (ANCEF), 2 grams
Fluids: normal saline 0.6 liters
Urine output: See chart
Tubes/Drains: NG tube and Foley catheter
Specimen: None
Complications: None
Findings: On EGD performed by Dr. XXXXX the tumor appeared to go from the pylorus into the second portion of the duodenum with near obstruction. Laparoscopically the tumor was found to be a large mass overlying the stomach and duodenum around the falciform ligament.
Indications for Procedure: Patient is a 83 y.o. female who was found to have a gastric outlet obstruction secondary to cancer which is nonoperative. Patient needs a palliative procedure to permit her to eat. I have discussed with the patient and his family the details of this condition, the treatment alternatives, the details of the procedure, the needs and benefits, the risks and potential complications, and the fact that there is no guarantee for success. They fully understand and wish to proceed with the surgery at this time.
Description of Technique: The patient was brought into the operating room and placed on the operating table in the supine position. After induction of General endotracheal anesthesia, the foley catheter was placed. An EGD was performed by Dr. XXXXX please see his note. With the scope in the stomach the margins of the mass as well as greater curve were delineated on the abdominal wall and marked with a marker. The abdomen was prepped with ChloraPrep and draped in the usual sterile fashion. Local consisting of Marcaine quarter strength was injected in the skin and an incision was made in the left lower abdomen. A 5 mm port was used to traverse the abdominal wound under direct vision. The abdomen was inflated to 15 mm Hg and then two other ports were placed. A 5 mm port was placed near the umbilicus and another was placed in the anterior axillary line. An exploration of the abdomen revealed the findings above. Some adhesions were taken down laterally by Dr. XXXXX using electrocautery with along with blunt and sharp dissection. After this was performed the greater omentum to be folded up to reveal the ligament of Treitz. The small bowel was followed from the ligament of Treitz until there was a comfortable length that would go antecolic and reach the stomach. Several sutures of 3-0 silk were then used to affix the antimesenteric border of the small bowel to the greater curve for an approximate length of 10-12 cm.
A 12 mm port was then placed in the left subcostal area near the midaxillary line. Skin was injected with local incision was made and 12 mm port was placed through the incision. Scissors electrocautery used to create 2 enterotomies one in the stomach and one in the small bowel. A laparoscopic stapler was placed through the 12 mm port and used to staple side to side the small bowel to the stomach using two 45 mm loads. The laparoscope was used to examine the anastomosis and was found to be hemostatic. Anesthesia then advanced the NG tube into the knee fair and limb of the gastrojejunostomy under direct vision. A running polyp glycolic suture was then used to close the enterotomies in 2 layers. First, a full layer was closed and then the same running suture was used to create a running Lembert suture to close the second layer. The suture was then cut.
The 12 mm port was removed and the fascia was closed using 0 Vicryl passed through the abdominal wall using the suture passer. The other ports were then removed and the skin incisions were closed using subcuticular stitches of 4-0 Monocryl on a PS 2 followed by Dermabond
The patient tolerated the procedure and anesthesia well without difficulty or complication. The patient was too weak for extubation and so was left intubated. The patient was then taken to the Post-Anesthesia Recovery Room in stable condition.
Postoperative Diagnosis: Same
Procedure Performed: Laparoscopic gastrojejunostomy
Surgeon:
assistant surgeon:
Surgical Staff:
Anesthesia: General
Estimated Blood Loss: Minimal
Antibiotics: cefazolin (ANCEF), 2 grams
Fluids: normal saline 0.6 liters
Urine output: See chart
Tubes/Drains: NG tube and Foley catheter
Specimen: None
Complications: None
Findings: On EGD performed by Dr. XXXXX the tumor appeared to go from the pylorus into the second portion of the duodenum with near obstruction. Laparoscopically the tumor was found to be a large mass overlying the stomach and duodenum around the falciform ligament.
Indications for Procedure: Patient is a 83 y.o. female who was found to have a gastric outlet obstruction secondary to cancer which is nonoperative. Patient needs a palliative procedure to permit her to eat. I have discussed with the patient and his family the details of this condition, the treatment alternatives, the details of the procedure, the needs and benefits, the risks and potential complications, and the fact that there is no guarantee for success. They fully understand and wish to proceed with the surgery at this time.
Description of Technique: The patient was brought into the operating room and placed on the operating table in the supine position. After induction of General endotracheal anesthesia, the foley catheter was placed. An EGD was performed by Dr. XXXXX please see his note. With the scope in the stomach the margins of the mass as well as greater curve were delineated on the abdominal wall and marked with a marker. The abdomen was prepped with ChloraPrep and draped in the usual sterile fashion. Local consisting of Marcaine quarter strength was injected in the skin and an incision was made in the left lower abdomen. A 5 mm port was used to traverse the abdominal wound under direct vision. The abdomen was inflated to 15 mm Hg and then two other ports were placed. A 5 mm port was placed near the umbilicus and another was placed in the anterior axillary line. An exploration of the abdomen revealed the findings above. Some adhesions were taken down laterally by Dr. XXXXX using electrocautery with along with blunt and sharp dissection. After this was performed the greater omentum to be folded up to reveal the ligament of Treitz. The small bowel was followed from the ligament of Treitz until there was a comfortable length that would go antecolic and reach the stomach. Several sutures of 3-0 silk were then used to affix the antimesenteric border of the small bowel to the greater curve for an approximate length of 10-12 cm.
A 12 mm port was then placed in the left subcostal area near the midaxillary line. Skin was injected with local incision was made and 12 mm port was placed through the incision. Scissors electrocautery used to create 2 enterotomies one in the stomach and one in the small bowel. A laparoscopic stapler was placed through the 12 mm port and used to staple side to side the small bowel to the stomach using two 45 mm loads. The laparoscope was used to examine the anastomosis and was found to be hemostatic. Anesthesia then advanced the NG tube into the knee fair and limb of the gastrojejunostomy under direct vision. A running polyp glycolic suture was then used to close the enterotomies in 2 layers. First, a full layer was closed and then the same running suture was used to create a running Lembert suture to close the second layer. The suture was then cut.
The 12 mm port was removed and the fascia was closed using 0 Vicryl passed through the abdominal wall using the suture passer. The other ports were then removed and the skin incisions were closed using subcuticular stitches of 4-0 Monocryl on a PS 2 followed by Dermabond
The patient tolerated the procedure and anesthesia well without difficulty or complication. The patient was too weak for extubation and so was left intubated. The patient was then taken to the Post-Anesthesia Recovery Room in stable condition.