Exp. laparotomy with stapled stricturoplasty
An incision was then created and carried down to the soft tissue utilizing electrocautery. The abdomen was then entered and minimal intraabdominal adhesions were appreciated. The small bowel was then withdrawn through the midline incision and it was followed down to the terminal ileum where thickening was appreciated at the prior small bowel anastomiosis. There was a noted stricture there that was less than a 1 cm in diameterr and this was just at the junciton of the ileum with the terminal ileum. The bowel was then run twice from the terminal eleum to the ligament of Treitz and the remainder of the bowel appeared quite healthy. There was some mild distention of the bowel proximal to the stricture, but other than that there was no evidence of any significant inflammation. No creeping fat, no fistulas, no clearcut strictures other nthan the anastomic stricture. At this time, it was decided to create an anastomiotic strictureplasty. The small bowel was brought into approximation with the cecum near the ileocecal valve. A back row of 3-0 silk sutures were placed. An enterotomy was created both on the antimesenteric tinea of the cecum as well as with the terminal ileum, then a GIA stapling device was advanced along this line and fired, creating a new ileocolic anastomosis through the prio anastomosis, effectively creating a strictureplasty and creating now a 3 cm anastomosis with the terminal ileum and the cecum. Once this was done, the enterotomy was created with a running closure of 3-0 Vicryl followed by imbricating layer of 3-0 silk and a front layer of silks was applied to the staple line. The anastomosis was then tested and found to be free of any evidence of leaking.
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