Abdominal Exploration with LOA for Bowel Obstruction
Date of Surgery -
Preop Diagnosis - small bowel obstruction
Postop Diagnosis - same
Surgeon - Dr. Luk / Dr. Tran
Assistant Surgeon -
Anesthesia - General
Blood Loss - Minimal
Complication - None
Findings - Adhesion
Specimens -
Procedure:
Diagnostic laparoscopic examination
Enterolysis
Small bowel resection and anastamosis
placement of tunnel intra-abdominal drain
Indication-
The patient was seen and examined. The patient has failed conservative treatment for bowel obstruction and therefore was brought to the or for surgical exploration.
Risks, benefits, and alternatives were discussed with patient, which includes, but are not limited to, postoperative or chronic pain, bleeding, wound infection, hematoma, injury to other organs, or need for further procedures or workup. Other Complications may include deep vein thrombosis(blood clots), as well as other side effects affecting other organ systems such as the heart or lungs, and in rare circumstances, death as a result of the above complications.
The patient understood and agreed to undergo the proposed procedure.
The patient was given preoperative antibiotics.
After consent was obtained, the patient was brought to the OR and underwent general anesthesia. The patient was prep and draped in the standard manner.
Timeout was performed and all was in agreement.
OPEN
A midline incision was made using a number 10 scalpel. The incision was carried down to the fascia. The fascia was opened carefully. Once I entered the abdominal cavity, retractors were placed as need for adequate visualization. The small bowel was carefully evaluated.
I ran the small bowel from the Ligament of Treitz to the terminal ileum. Enterolysis was performed to free up the adhesion.
RESECTION IF DONE ****************************
Once the obstruction has been addressed and corrected, I evaluated the colon. There was no pathology found. The rest of the abdominal cavity was normal for the patient's age.
Next, the small bowel was placed back into the abdominal cavity. The abdominal cavity was irrigated using sterile saline. The excess fluid was then removed.
Hemostasis was completely obtained. No injury to the other organs were seen.
At the end of the case, counts were carried out. When instrument, sponge, and needle
counts were completed and reported to me as correct, then I began the closure.
The fascia was closed using running loop PDS sutures. The skin was closed using skin staples.
The pt tolerated the procedure well and was transferred to the recovery room in stable and satisfactory conditions.