Any help with the below OP report would be greatly appreciated.
Pre and Post op diagnosis: Type II endoleak
Procedure Performed: 1. Rt infrarenal aortic artery exploration. 2. Ligation of type II endoleak, 3. Exploratory laparotomy
Indications for procedure: The patient is well know male with a past medical history significant for infrarenal aortic aneurysm. He had initial repair including an AneuRx graft. This was extended secondary to presumptive type I endoleak. He also had additional cuffs placed in terms of a tunnel graft. He was seen by the dictating physician and subsequently had type II endoleak from his hypogastric arteries. He was converted to an aorta uni-body graft with fem-fem bypass. He comes to operating room today with persistent type II endoleak. The patient understoon the risks and benefits of the procedure and subsequently consented to it.
PROCEDURE IN DETAIL: After proper consent and permit were secured on the chart, the patient was brought to the OR. The patient underwent general endotrachael intubation without difficulity. The patient underwent a right internal jugular line placed without difficulity. The patient's abdomen and bilateral groins were prepped and draped in the standard sterile fashion. A large incision from the Xiphoid to the pubic subcutaneous tissues to the fascia. The fascia was subsequently then entered at this time under direct vision. The peritoneum was then explored at this time. There were no obvious masses of the small bowel nor of the colon nor liver. An Omnicell retraction system was then brought to the field. Traction on the transverse colon was then brought down. The left lobe of the liver attachments were then taken down. The crus of the diaphragm was then taken down. The supraceliac aorta was dissected free at this time. A clamp was then notched into place and left open.
Attention was then turned to the infrarenal aortic aneurysm. A Kocher maneuver was then used to take down the lateral attachments of the third and fourth portions of the duodenum. The small bowell was then retracted to the right side of the patient. An Omnicell retraction system was then used to isolate the aorta proximally and distally. At this point, the aorta was entered. All thrombus was removed. Four lumbar arteries were oversewn with 4-0 and 3-0 Prolene. They were also oversewn with 2-0 silk. A middle sacral artery was also oversewn at this time. The remainder of the sac was explored at this time and no additional endoleak was seen. Sac was then washed out and had thrombin and Gelform placed into it. After hemostasis was achieved, the sac was closed with #1 PDS in a running horizonal mattress fashion. The peritoneum was then closed over the sac using 3-0 Vicryl sutures. The abdomen was then washed out, all bowel replaced back into the abdomen and it was closed with a running Maxon suture caudad and cephalad. It was tied in the middle. The skin was then stapled closed. Dry dressing was then applied.
Thanks for any help on this.
Pre and Post op diagnosis: Type II endoleak
Procedure Performed: 1. Rt infrarenal aortic artery exploration. 2. Ligation of type II endoleak, 3. Exploratory laparotomy
Indications for procedure: The patient is well know male with a past medical history significant for infrarenal aortic aneurysm. He had initial repair including an AneuRx graft. This was extended secondary to presumptive type I endoleak. He also had additional cuffs placed in terms of a tunnel graft. He was seen by the dictating physician and subsequently had type II endoleak from his hypogastric arteries. He was converted to an aorta uni-body graft with fem-fem bypass. He comes to operating room today with persistent type II endoleak. The patient understoon the risks and benefits of the procedure and subsequently consented to it.
PROCEDURE IN DETAIL: After proper consent and permit were secured on the chart, the patient was brought to the OR. The patient underwent general endotrachael intubation without difficulity. The patient underwent a right internal jugular line placed without difficulity. The patient's abdomen and bilateral groins were prepped and draped in the standard sterile fashion. A large incision from the Xiphoid to the pubic subcutaneous tissues to the fascia. The fascia was subsequently then entered at this time under direct vision. The peritoneum was then explored at this time. There were no obvious masses of the small bowel nor of the colon nor liver. An Omnicell retraction system was then brought to the field. Traction on the transverse colon was then brought down. The left lobe of the liver attachments were then taken down. The crus of the diaphragm was then taken down. The supraceliac aorta was dissected free at this time. A clamp was then notched into place and left open.
Attention was then turned to the infrarenal aortic aneurysm. A Kocher maneuver was then used to take down the lateral attachments of the third and fourth portions of the duodenum. The small bowell was then retracted to the right side of the patient. An Omnicell retraction system was then used to isolate the aorta proximally and distally. At this point, the aorta was entered. All thrombus was removed. Four lumbar arteries were oversewn with 4-0 and 3-0 Prolene. They were also oversewn with 2-0 silk. A middle sacral artery was also oversewn at this time. The remainder of the sac was explored at this time and no additional endoleak was seen. Sac was then washed out and had thrombin and Gelform placed into it. After hemostasis was achieved, the sac was closed with #1 PDS in a running horizonal mattress fashion. The peritoneum was then closed over the sac using 3-0 Vicryl sutures. The abdomen was then washed out, all bowel replaced back into the abdomen and it was closed with a running Maxon suture caudad and cephalad. It was tied in the middle. The skin was then stapled closed. Dry dressing was then applied.
Thanks for any help on this.
