PREOPERATIVE DIAGNOSES:
1. Pyloric stenosis.
2. Neonatal tooth.
POSTOPERATIVE DIAGNOSES:
1. Pyloric stenosis.
2. Neonatal tooth.
OPERATIONS PERFORMED:
1. Laparoscopic pyloromyotomy.
2. Removal of neonatal tooth.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and prepped and draped in the usual sterile fashion in the supine position. After adequate general anesthesia was obtained, an incision was made in the umbilicus. This was carried down through the subcutaneous tissues with a knife and then a Step sheath with Veress needle was placed into the abdominal cavity.
A 5 mm trocar and port were then placed through the sheath and into the abdomen. We then placed a right upper quadrant 3 mm trocar and port, and the pyloromyotomy blade was brought into the mid upper abdomen under direct vision with the camera. Once all the tools were in place, the first part of the duodenum distal to the pylorus was grasped in the normal area and an incision was made over the pylorus, which was quite hypertrophic on visual examination and palpation. This was carried down to the normal stomach.
The pyloromyotomy blade was used to make this incision, and then, after the incision was initially made, the blade was retracted and the blunt portion of the pyloromyotomy tool was used to separate the muscle initially. The muscle separated and it was bluntly separated throughout its entire length from the normal stomach down to duodenum. There was no evidence of bile or gastric extravasation seen and the mucosa appears intact. The two edges of the pylorus muscle itself did move independently at the end of the procedure indicating an adequate pyloromyotomy. Again, some pressure was placed on the stomach in order to try and determine if there was any egress of gastric contents and none was seen.
All the ports were then removed and then a 3-0 Vicryl stitch was used to close the fascia of the umbilical port site. The skin was closed with three interrupted 5-0 Monocryl sutures and then a single interrupted 5-0 Monocryl suture was used in the right upper quadrant site. Only a Steri-Strip was needed for the pyloromyotomy blade access site. After dressings were finally applied and 0.25% Marcaine was used for local anesthesia postoperatively, the patient was then woken up out of anesthesia. Just prior to awakening from anesthesia, the neonatal tooth that was seen initially was removed by simply taking a toothed Adson and using gentle turning motion to bring the tooth out.
The tooth was removed easily and without complication and the area had pressure held on it for approximately 4 minutes to control the bleeding. It was completely hemostatic after a few minutes of pressure and then the patient was woken up out of anesthesia and brought back to the recovery room in good condition. The patient tolerated the procedure well. Sponge and needle counts were correct at the end of procedure.
