THANKS
PROCEDURES PERFORMED:
1. Exploratory laparotomy
2. Lysis of adhesions
3. Small bowel diverticulum resection
*resected
*
*
PROCEDURE IN DETAIL: After informed consent was obtained, the patient was brought to the Operative Theater and placed in in the supine position. After adequate anesthesia the patient was prepped and draped in the usual sterile fashion. A timeout procedure was performed and a lower midline abdominal incision was made through his previous incision site. The incision was carried down through the subcutaneous tissue to the linea alba. The fascia was incised and the abdomen was entered. There were minimal adhesions to the anterior abdominal wall. The ligament of treitz was identified and we ran the small bowel until we identified a transition point in the right lower quadrant of the abdomen. There was evidence of omental adhesions to the cecum. The small bowel was also adhesed at this point. The adhesions were taken down and we continued to run the small bowel to the ileocecal valve. There were a few additional adhesions in the area of the terminal ileum which we lysed as well. There was no other evidence of active obstruction noted.
We then milked the contents of the small intestines proximally allowing to the drain into the NGT. We confirmed the position of the tube in the stomach. We did identify two serosal tears, one in the proximal small bowel and one in the distal small bowel which were repaired(imbricating sutures) with interrupted 3-0 Vicryls. While running the small bowel we had noted a wide-mouthed diverticulum which contained a soft mass which felt like a lipoma. There was concern that this could be a lead point for intususception in the future and decision was to resect it using a TIA stapler 55 green load. We oversewed the staple line with interrupted 3-0 Vicryls in a Lembert fashion. We replaced the small bowel into the abdomen. We irrigated the abdomen. We placed two pieces of seprafilm in the right lower quadrant in the area of the distal adhesions. We injected Exparel into the anterior abdominal wall for post-operative analgesia. We then closed, running the fascia with a number 1 PDS and closed the skin with a skin stapler. A sterile dressing was applied. The patient tolerated the procedure well and was transported to the recovery room in stable condition
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