DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Acute appendicitis.
POSTOPERATIVE DIAGNOSIS:
Acute appendicitis.
OPERATION PERFORMED:
Laparoscopic appendectomy.
SURGEON: John Doe, MD
SEDATION:
General endotracheal anesthetic.
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
None.
INDICATIONS FOR PROCEDURE:
The patient is a (XX)-year-old female who presented with signs and symptoms consistent with acute appendicitis. She was seen on preoperative CT imaging to have an inflamed appendix. The risks and benefits of the procedure including the possibility of bleeding, infection, intra-abdominal abscess and the need for open operation were reviewed in detail with the patient and the patient agreed to proceed with the operation.
DESCRIPTION OF OPERATION:
After informed consent was obtained, the patient was then brought to the operating room and placed on the operating table in the supine position. After induction of the general anesthetic, the abdomen was prepped and draped in the usual sterile fashion. The patient had been given preoperative platelet transfusions secondary to thrombocytopenia noted in the emergency room, as well as platelet function assay abnormality. Platelets were completely transfused to the patient prior to the first incision.
A small stab incision was made through the umbilicus through which a bladeless 11 mm trocar was inserted without difficulty. After establish the pneumoperitoneum, the patient was placed in Trendelenburg position. Two additional 5 mm trocars were inserted in the left lower abdomen, all under direct visualization. An obviously inflamed, edematous and borderline gangrenous appendix was seen adherent to the anterior abdominal wall.
The terminal ileum was also draped over in a rather adherent fashion. Combination of blunt dissection as well as Metzenbaum scissors were used to gently remove the terminal ileum from the inflamed appendix. There was a small deserosalized area on the anterior surface of the terminal ileum that was buttressed with interrupted 3-0 silk suture tied laparoscopically. To perform this repair, the more superior 5 mm trocar was upsized to an 11 mm trocar. The mesoappendix was then divided with an Ace Harmonic scalpel with good hemostasis. The base of the appendix was clearly identified in relationship to the cecum and terminal ileum.
The appendiceal base was then ligated with 0 Vicryl Endoloop suture and the more distal appendiceal stump was ligated as well with a second 0 Vicryl Endoloop suture. The point between the Endoloops was then divided with Harmonic scalpel and the appendix was then placed in an EndoCatch bag and removed from the umbilical port side with no contact made between the contents of the bag and the skin or incision.
The right lower quadrant was then copiously irrigated, suctioned dry and inspected for adequate hemostasis. A 15 mm Blake drain was then placed in the vicinity of the serosal repair and the appendiceal stump and brought out through the inferior 5 mm trocar site. All needle and sponge counts were correct at the conclusion of the procedure. The umbilical fascial defect was closed with 0 Vicryl suture using a cone closure device and the skin incisions were then anesthetized with a local anesthetic and closed in subcuticular fashion.
Drain was secured to the skin with a nonabsorbable suture. The patient tolerated the procedure well, awoke from anesthetic in stable condition and was brought back to recovery without incident.
