A little background — the patient went through multiple surgeries after a whipple procedure, lots of complications. Went back in, starting taking portions of bowel. Basically now the surgeon is performing "damage control" type measures. He is keeping the abd open after every time he goes back in to repair something else.
Here is the portion of the operative note:
Proximal ileo-ileal anastomotic segment bearing dehiscense was gently mobilized and brought out via main abd incision; the bowel segment was securely anchored to right lateral fascail margins at 8:00 and 10:00 position with interrupted sero-muscular 4-0 PDS sutures. Distal ileo-descending colonic anastomotic segment bearing dehiscence was gently mobilized and brought out via main abd incision; the bowel segment was securely anchored to inferior fascial margins at 5:00 to 7:00 position with interrupted sero-muscular 4-0 PDS sutures. Both the bowel exteriorization sites were reinforced with Tisseel 10mL spray x4 and application of Gelfoam pads.
It seems that he is taking the anastomotic segments and suturing them to the edges of the abdominal wound.
Hope someone out there can help! Thanks in advance!!