DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Obesity.
2. Hypertension.
3. Arthritis.
4. Hypercholesterolemia.
5. Reflux disease.
POSTOPERATIVE DIAGNOSES:
1. Obesity.
2. Hypertension.
3. Arthritis.
4. Hypercholesterolemia.
5. Reflux disease.
PROCEDURES PERFORMED:
1. Laparoscopic Roux-en-Y gastric bypass with Silastic ring.
2. Gastrostomy tube placement.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
DRAINS: A 19 round Blake drain.
ESTIMATED BLOOD LOSS: 100 mL.
SPECIMENS: None.
DESCRIPTION OF OPERATION: The patient was identified in holding and brought to the operating suite, where the patient was placed in supine position and general endotracheal anesthesia was induced without complications. The patient’s abdomen was then prepped and draped in the usual sterile manner. Abdominal cavity was entered with an Optiview trocar under direct visualization and CO2 insufflation of the abdomen was achieved.
Under direct visualization, two trocars were placed in the left side of the abdomen followed by three trocars in the right side of the abdomen. A liver retractor was inserted in the right lateral-most trocar site. The fat pad at the angle of His was identified and excised and the peritoneal reflection at the angle of His opened using blunt dissection. Next, a window was created into the lesser sac along the lesser curvature. A divided transverse staple line was then created perpendicular to the lesser curvature, 6 cm distal to the GE junction.
Next, a divided vertical staple line was created from the transverse staple line up to the angle of His using two green loads and a blue load of Ethicon linear staples with SeamGuard as a buttressing device. It completely divided the proximal gastric pouch. An anvil corresponding to a 21 circular stapler was then positioned in the distal aspect of the gastric pouch using an orogastric tube and a transoral transesophageal technique. A Silastic ring measuring 16.25 cm in circumference was then fashioned around the distal aspect of the gastric pouch just proximal to the anvil.
Next, a Penrose drain was placed into the lesser sac. The ligament of Treitz was identified. A window was created in the transverse mesocolon just above and to the patient’s left of the ligament of Treitz and one end of the Penrose drain retrieved. Small bowel was measured for a distance of 45 cm from the ligament of Treitz and divided. It was measured an additional 75 cm and the proximal small bowel stump was then anastomosed to the 75 cm mark in a side-to-side functional end-to-end fashion with a linear stapler. The resulting enterotomy was closed with Vicryl in a running two-layer fashion. The mesenteric defect was closed with silk in a running fashion. The distal divided small bowel stump which represented the alimentary limb was then brought retrocolic, retrogastric with the use of a Penrose drain.
A 21 circular stapler was then used to create a side alimentary limb to end gastric pouch anastomosis. The redundant afferent stump of the alimentary limb was amputated with a linear stapler. The gastrojejunal anastomosis was then reinforced with Vicryl in a running fashion. The retrocolic window was closed to the alimentary limb with silk in running fashion to include Petersen space in the closure to prevent internal hernias. The upper abdomen was then carefully irrigated. A gastrostomy tube was then placed percutaneously through the anterior abdominal wall to a Silastic ring to serve as a radiological marker and into the excluded stomach. The excluded stomach was tacked up to the anterior abdominal wall with silk in an interrupted fashion around the gastrostomy tube.
A 19 round Blake drain was positioned in the lesser sac. All trocars including the liver retractor were removed. On the left side, trocar site which was dilated to accommodate a 21 circular stapler was closed by reapproximating the fascia with 0 Prolene. All trocar sites were closed by reapproximating the skin with 4-0 Vicryl. This was reinforced with Dermabond. The patient was then extubated and then brought to postanesthesia care unit in stable condition.
