DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed on the table in the supine position for right colon resection. After adequate induction of general anesthesia with endotracheal intubation, a Foley catheter was placed without difficulty. The abdomen was then shaved, prepped, and draped in the usual sterile fashion.
A midline incision was then made and carried sharply down to fascia, which was opened for the extent of the incision, taking care to avoid injury to underlying organs. Once exposure was obtained, exploration was undertaken. The liver was without palpable abnormality. The gallbladder was normal. The tumor was palpable at the level of the ileocecal valve. The cecum was, therefore, grasped and elevated.
The avascular retrocecal plane was entered and the mesentery of the right colon was carefully dissected up off the retroperitoneal structures up to the level of the duodenum. The lateral attachments were then sharply taken down, completely mobilizing the hepatic flexure. Complete mobilization was undertaken to the level of the mid transverse colon. The ileocolic artery was divided and ligated at its base.
The right colic artery was divided and ligated as was the right branch of the middle colic artery. Next, the terminal ileum was divided with a GIA stapling device. The transverse colon was likewise divided with the GIA stapling device. The specimen was handed off the field and given to the pathologist in the room, who opened it and found the ulcerated mass next to the ileocecal valve.
A side-to-side functional end-to-end anastomosis was performed without difficulty. The staple line was inspected and seen to be hemostatic. This was closed with a TLH-60 stapling device and the staple line was oversewn with interrupted 3-0 Vicryl sutures. The apex of the anastomosis was reinforced with Vicryl as well. The mesenteric defect was closed with running monofilament suture.
The small bowel was returned to the intraabdominal cavity in gentle S-shaped curves and covered with omentum and Seprafilm. The sponge and needle count was reported as correct. The posterior sheath was closed with chromic. The fascia of the abdominal wall was closed with two separate looped 0 Maxon sutures. The skin was stapled closed.
The patient tolerated the procedure well. He was awakened, extubated, and returned to the PACU in stable condition.
