EngageMed2
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Can someone please help with this?
DESCRIPTION OF PROCEDURE:
Written informed consent was obtained from the patient's spouse. He was taken from the surgical ICU to the operating room suite, placed supine on the operating room table. Anesthesia was introduced. Antibiotics have been scheduled. He is also on multiple pressors and a bicarb drip. Abdomen was prepped and draped in normal sterile fashion. Time-out was called. Staples were removed and we entered the subcu space. Fascial sutures were then removed and we entered the abdomen. Care was taken to clear the peritoneal surface from the underlying bowel in both directions and a self-retaining Bookwalter retractor was placed. Gelatinous hematoma was then carefully removed and suctioned and irrigated from the right upper quadrant until the area was clean. We then carefully examined the biliary anastomosis, pancreatic anastomosis, and gastrojejunal anastomosis and all anastomoses were intact. The jejunal to jejunum anastomosis was intact and the feeding tube was in appropriate position. There was no evidence of ischemia of the transverse or ascending colon and the bowel appeared to be in its normal orientation through the bare window through the transverse mesocolon and antecolic over the distal transverse colon to the stomach. We therefore elected to washout thoroughly. Once satisfied with the washout, we then proceeded with a biliary drainage catheter. A trocar was placed through a small hole in the duodenum through the biliary anastomosis and then directed laterally through the liver parenchyma. It was then brought through the abdominal wall and secured to the skin with nylon suture. The catheter flushed easily and drew back bile and duodenal contents and was then placed to gravity drainage. We then placed two 19-French round Blake drains to the right abdominal wall. The superior drain was placed in the subhepatic space. The inferior drain was placed in the peripancreatic space. We then placed the drain in the left abdomen and directed it toward the pelvis to collect any dependent fluid there. We then closed the fascia with interrupted #1 Vicryl sutures. We irrigated the subcu tissue thoroughly and then loosely closed with interrupted 2-0 Prolene vertical mattress sutures. All three drains were secured to the skin. We then cleaned and dressed the abdomen with Kerlix packing, 4x4s, and Medipore tape. Drain exit sites were dressed with island dressing. The patient was then taken from the operating room back to the surgical ICU. He remained intubated on pressors for further resuscitation and support. Operative findings were discussed with the patient's wife. The patient remains in critical condition with high risk of mortality. All lap, sponge, instrument, and needle counts were correct prior to completion of the case.
DESCRIPTION OF PROCEDURE:
Written informed consent was obtained from the patient's spouse. He was taken from the surgical ICU to the operating room suite, placed supine on the operating room table. Anesthesia was introduced. Antibiotics have been scheduled. He is also on multiple pressors and a bicarb drip. Abdomen was prepped and draped in normal sterile fashion. Time-out was called. Staples were removed and we entered the subcu space. Fascial sutures were then removed and we entered the abdomen. Care was taken to clear the peritoneal surface from the underlying bowel in both directions and a self-retaining Bookwalter retractor was placed. Gelatinous hematoma was then carefully removed and suctioned and irrigated from the right upper quadrant until the area was clean. We then carefully examined the biliary anastomosis, pancreatic anastomosis, and gastrojejunal anastomosis and all anastomoses were intact. The jejunal to jejunum anastomosis was intact and the feeding tube was in appropriate position. There was no evidence of ischemia of the transverse or ascending colon and the bowel appeared to be in its normal orientation through the bare window through the transverse mesocolon and antecolic over the distal transverse colon to the stomach. We therefore elected to washout thoroughly. Once satisfied with the washout, we then proceeded with a biliary drainage catheter. A trocar was placed through a small hole in the duodenum through the biliary anastomosis and then directed laterally through the liver parenchyma. It was then brought through the abdominal wall and secured to the skin with nylon suture. The catheter flushed easily and drew back bile and duodenal contents and was then placed to gravity drainage. We then placed two 19-French round Blake drains to the right abdominal wall. The superior drain was placed in the subhepatic space. The inferior drain was placed in the peripancreatic space. We then placed the drain in the left abdomen and directed it toward the pelvis to collect any dependent fluid there. We then closed the fascia with interrupted #1 Vicryl sutures. We irrigated the subcu tissue thoroughly and then loosely closed with interrupted 2-0 Prolene vertical mattress sutures. All three drains were secured to the skin. We then cleaned and dressed the abdomen with Kerlix packing, 4x4s, and Medipore tape. Drain exit sites were dressed with island dressing. The patient was then taken from the operating room back to the surgical ICU. He remained intubated on pressors for further resuscitation and support. Operative findings were discussed with the patient's wife. The patient remains in critical condition with high risk of mortality. All lap, sponge, instrument, and needle counts were correct prior to completion of the case.