Operative Note |
DIAGNOSIS: Acute perforated appendicitis. |
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SUMMARY: The patient was brought into the operating room
and prepped and draped in the usual sterile fashion. A 10 mm trocar was placed through a curvilinear incision in the supraumbilical
region through the umbilical hernia defect. Next, a 12 mm trocar was placed in the left lower quadrant under direct visualization
after insufflation of the pneumoperitoneum. A 5 mm trocar was placed in the suprapubic region. Upon inspection, the appendix
was seen adherent to the right lateral pelvic wall. It was seen to be perforated on the inferior margin with pus present. This was irrigated. The appendix was then dissected free from the lateral abdominal wall. Once the appendix was free from
the abdominal wall, the appendix and mesoappendix were dissected free from the base of the colon to allow adequate transection. Next, the window was established through the base of the mesoappendix and the mesoappendix was then divided with a vascular load on
the endovascular stapler. During further dissection, there was a small amount of bleeding that was encountered from the mesoappendix. This was controlled with a 1 cm hemoclip. After this was done, the appendix was then taken using a blue load on a 45 endovascular
stapler. After the appendix was transected, it was placed in an endobag and brought out through the left lateral incision. Once this was done, the abdomen was irrigated copiously with 3 liters of sterile saline. After copious irrigation and clear
return of fluid, the trocars were removed and the pneumoperitoneum was evacuated along with the fluid and the midline supraumbilical
fascia was reapproximated with a figure-of-eight Vicryl sutures. Once this was done, all skin sites were closed with interrupted
Vicryl subcuticular sutures. Sterile dressing was applied, the patient was awakened, and extubated and taken to post-anesthesia
care unit in stable condition. Lap and needle counts were correct X2 as reported to me.
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