Robotic resection and repair of gastrocolic fistula


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I have been fighting with this OP note and I have had it! Please, help! Any thoughts or ideas would be greatly appreciated!

Procedure: Robotic resection of the gastrocolic fistula and insertion of gastrostomy tube, repair of gastrocolic fistula

Description of procedure: Patient was taken to OP, placed under general anesthesia. The abdomen was prepared with chloraprep and draped in sterile fashion. The old G-tube was decompressed and removed. The abdomen was insufflated using an incision just around the umbilicus with a veress needle. Once pneumoperitoneum was established, the a 12 mm optical port, a 5 mm optical port and two 8 mm ports were inserted. The patient was placed in slight reverse trendelenburg and the robot was docked. Incision was begun with scissor in arm 1 and bipolar cautery in arm 2. The adhesions were taken down with the scissor and occasional use of monopolar and bipolar cautery was made. Dissection was carried until the gastrocolic fistula was found. Using bipolar monopolar cautery, the greater curvature was dissected free from the colon. This dissection allowed isolation of the attachments which could be seen from the gastric wall to the transverse colon. Using a stapler, this attachment was taken down, performing a partial gastrectomy and a partial colectomy. The fistula was placed on the side. The staple lines were oversewn with 0 vicryl sutures. Once completed, then the stomach was carefully observed and checked to find a particular spot, which would reach the abdominal wall without tension. The enterotomy was performed in this area. A g-tube was inserted through the abdominal wall and placed securely within the stomach. The gastrostomy was then sutured to the abdominal wall. Staple lines were again checked, were oversewn and they appeared to be intact.