MEZIESKY
Guru
Help please,
Not sure on this one it not a true rt colectomy 44205
. He only removed a corner of the cecum. Report as follows.
INDICATIONS: This pleasant 71-year-old patient of Dr. _____ was referred to my
office after undergoing screening colonoscopy which revealed a serrated adenoma
of the appendiceal orifice. The adenoma could not be resected endoscopically
and he was referred for surgical intervention.
The patient had had previous open cholecystectomy. I recommended a laparoscopic
approach with resection of the appendiceal orifice to clear the polyp and I
explained to him that it was possible that we could not clear this completely
and he may require re-exploration with formal ileocecostomy. Other risks such
as bleeding, infection, need for reoperation and postoperative problems such as
pneumonia or ileus were discussed and understood. Consent was obtained prior to
proceeding.
DESCRIPTION OF PROCEDURE: The patient was brought to the OR and placed under
general anesthesia and the abdomen was prepped and draped in usual sterile
fashion. A Foley catheter was inserted as well as an orogastric tube in the
abdomen and the planned procedure was confirmed with the operating team during
the time-out process. We started by obtaining pneumoperitoneum through a
supraumbilical stab incision using Veress needle technique. Under 10 mm of
pressure, a 5 mm port was placed under direct vision. Subsequent ports were
placed in the suprapubic measuring 12 and left lower quadrant measuring 5,
respectively. Inspection of the right lower quadrant revealed dense adhesions
following his open appendectomy, which were taken down sharply with laparoscopic
Metzenbaum scissors, thereby mobilizing the terminal ileum and cecum. The cecum
was rather floppy and the ileocecal junction was defined appropriately.
Elevating the corner of the cecum up off the floor, we were able to get a
laparoscopic 60 mm stapler across the portion of the cecum where the appendiceal
orifice would be, which stayed clear of the ileocecal junction. The corner of
the cecum was removed using 2 applications of the stapler and brought to the
back table where a small apparent adenomatous polyp at the appendiceal orifice
and a little bit of surrounding biopsy site was noted and sent to pathology for
evaluation. We returned to the abdomen and the area was inspected. Hemostasis
was assured. The area was irrigated and we turned towards closing.
Pneumoperitoneum was released, but prior to doing so, the fascia at the 12 mm
port site was closed with a suture assist device using 0 Vicryl and after
pneumoperitoneum was released, all skin sites were closed with 4-0 Monocryl.
Patient tolerated the procedure well and was returned to the recovery room in
stable condition.
Not sure on this one it not a true rt colectomy 44205
. He only removed a corner of the cecum. Report as follows.
INDICATIONS: This pleasant 71-year-old patient of Dr. _____ was referred to my
office after undergoing screening colonoscopy which revealed a serrated adenoma
of the appendiceal orifice. The adenoma could not be resected endoscopically
and he was referred for surgical intervention.
The patient had had previous open cholecystectomy. I recommended a laparoscopic
approach with resection of the appendiceal orifice to clear the polyp and I
explained to him that it was possible that we could not clear this completely
and he may require re-exploration with formal ileocecostomy. Other risks such
as bleeding, infection, need for reoperation and postoperative problems such as
pneumonia or ileus were discussed and understood. Consent was obtained prior to
proceeding.
DESCRIPTION OF PROCEDURE: The patient was brought to the OR and placed under
general anesthesia and the abdomen was prepped and draped in usual sterile
fashion. A Foley catheter was inserted as well as an orogastric tube in the
abdomen and the planned procedure was confirmed with the operating team during
the time-out process. We started by obtaining pneumoperitoneum through a
supraumbilical stab incision using Veress needle technique. Under 10 mm of
pressure, a 5 mm port was placed under direct vision. Subsequent ports were
placed in the suprapubic measuring 12 and left lower quadrant measuring 5,
respectively. Inspection of the right lower quadrant revealed dense adhesions
following his open appendectomy, which were taken down sharply with laparoscopic
Metzenbaum scissors, thereby mobilizing the terminal ileum and cecum. The cecum
was rather floppy and the ileocecal junction was defined appropriately.
Elevating the corner of the cecum up off the floor, we were able to get a
laparoscopic 60 mm stapler across the portion of the cecum where the appendiceal
orifice would be, which stayed clear of the ileocecal junction. The corner of
the cecum was removed using 2 applications of the stapler and brought to the
back table where a small apparent adenomatous polyp at the appendiceal orifice
and a little bit of surrounding biopsy site was noted and sent to pathology for
evaluation. We returned to the abdomen and the area was inspected. Hemostasis
was assured. The area was irrigated and we turned towards closing.
Pneumoperitoneum was released, but prior to doing so, the fascia at the 12 mm
port site was closed with a suture assist device using 0 Vicryl and after
pneumoperitoneum was released, all skin sites were closed with 4-0 Monocryl.
Patient tolerated the procedure well and was returned to the recovery room in
stable condition.
