Open Sigmoidectomy with Anastamosis
Date of Surgery -
Preop Diagnosis -
Postop Diagnosis -
Surgeon - Dr. Luk/Dr. Dan Tran
Assistant Surgeon -
Anesthesia -
Blood Loss - Minimal
Complication - None
Findings -
Specimens -
Indication-
Procedure Performed-
1) sigmoid resection
2) take down of splenic flexure
3) incidental appendectomy
4) placement of tunnel intra-abdominal drain
DESCRIPTION OF PROCEDURE:
The proposed procedure was discussed with the patient along with alternatives. All risks and benefits were explained to the patient and he/she agreed to the procedure.
The patient was brought to the OR, placed supine on the OR table. The patient was placed in supine and lithotomy position. The patient was prepped and draped using standard prep. A standard midline incision was performed using 10. Scalpel. Dissection down to the fascia using electrocautery. The fascia was opened.
The abdominal retractor was placed for exposure.
Care was taken during the placement of the retractors to to avoid injuring any important structures.
Headlight were used for proper illumination
Description the finding here...........................
Mobilization was performed mainly using blunt dissection to separate the sigmoid colon and rectum from the pelvic sidewall.
Next, the upper left colon was taken down using the electrocautery along the left line of Toldt
This was performed starting at the mid sigmoid and working up towards the healthier proximal sigmoid.
The splenic flexure was taken down to help increase the length and mobilization for the anastomosis and resection.
This was done using the electrocautery as well as the ultrasonic scalpel
If anastomosis is done with the EEA stapler ...........................................
The segment of diseased bowel was divided proximal and distal to where disease start and ends.
This leaves behind healthy rectal stump and healthy proximal sigmoid colon.
The intraluminal stapler anvil was then placed into the proximal bowel. The tip of anvil was brought out to the bowel wall.
The opening was closed using a perpendicular stapler. In this way, the anvil was locked into the proximal sigmoid colon in preparation for the anastomosis
Finally, anastomosis was performed, connecting the proximal sigmoid colon down to the rectal stump without any problem. The end of the stapler was placed into the rectal stump and it was allowed to connect with the anvil. Once we performed the anastomosis, we tested the anastomosis under water to make sure there was no bubbling indicating any leakage and there was none.
Incidental appendectomy if done
The clinical decision was made to remove the appendix since any future surgery for appendectomy may be complicated by adhesions and may not be achievable by laparoscopic method.
The appendix was identified, the mesentery was mobilized using Harmonic scalpel. The base of the appendix was divided using a GI stapler.
The appendix was passed off as specimen.
Closure
Finally, we changed gowns and gloves and we irrigated the abdominal cavity, removing excess fluid.
Before closing the fascia, we performed instrument, needle, and sponge counts.
When these were reported to me as correct, then the fascia was closed
The midline incision fascia was closed using running looped PDS suture. The skin was stapled.
The patient tolerated the procedure well. At the end of the case, all instruments, sponge, and needle counts were reported to me as correct. The patient was transferred to the recovery room in stable and satisfactory condition.