PREOPERATIVE DIAGNOSIS:
Tracheoesophageal fistula with duodenal atresia.
POSTOPERATIVE DIAGNOSIS:
Tracheoesophageal fistula with duodenal atresia.
OPERATION PERFORMED:
Gastrostomy tube placement.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: General.
COMPLICATIONS: None.
INDICATION FOR OPERATION: The patient is a newborn male with a history of recently diagnosed tracheoesophageal fistula and also appears to have duodenal atresia, given the fact that there appears to be a double bubble sign on the abdominal x-ray. Given this, he has had increasing episodes of apnea and bradycardia and is suspected to be suffering from aspiration.
Therefore, gastrostomy is needed in order to decompress the stomach. He is planned for a tracheoesophageal fistula repair tomorrow. The family was explained the risks, benefits, options and potential complications of the procedure, which they understood and desired to proceed.
FINDINGS AND PROCEDURE: 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 over the left rectus sheath approximately 2 cm below the left costal margin. This was carried down through the subcutaneous tissues with Bovie electrocautery and through the abdominal wall musculature with the same.
The abdomen was opened through the peritoneum and into the abdominal cavity. The liver was retracted superiorly and the stomach was visualized underneath this. The stomach was brought up into the wound, and using 3-0 Vicryl stitches, 2 circular pursestring Stamm gastrostomy sutures were placed in the anterior wall of the stomach.
We then made a gastrotomy opening within the stomach using the Bovie electrocautery and placed a 12-French Pezzer catheter into this gastrostomy site.
The pursestrings were then tied around the Pezzer catheter and the catheter itself was left open. We then closed the fascia of the wound using 4 interrupted 3-0 Vicryl sutures along the full thickness of the anterior fascia and peritoneum, all the way through full thickness of the musculature, to close the abdominal wall.
Then, the skin was closed with interrupted 5-0 Monocryl sutures. The tube was then taped in place. The patient was woken up out of anesthesia and brought back to the neonatal intensive care unit.
There were no complications during the procedure and the patient tolerated the procedure well. There was a large air leak from the gastrostomy tube after final placement. This is consistent with this patient’s tracheoesophageal fistula.
