DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Multiparity.
2. Fertility.
3. Desired sterilization.
POSTOPERATIVE DIAGNOSES:
1. Multiparity.
2. Fertility.
3. Desired sterilization.
OPERATION PERFORMED: Bilateral modified Pomeroy postpartum tubal ligation.
SURGEON: John Doe, MD
ANESTHESIA: Epidural.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Minimal.
SPECIMENS TO PATHOLOGY: Bilateral tube segments.
DRAINS: Bladder straight catheterized intraoperatively.
OPERATIVE FINDINGS: Normal fallopian tubes bilaterally.
DESCRIPTION OF OPERATION: The patient was moved to the operating suite in stable condition. She had epidural anesthesia onboard from her recent delivery. She had signed the appropriate consent forms. The patient was well aware of the permanency of this procedure as well as options such as vasectomy, birth control measures or tubal ligation later on, as well as the known failure rates in the range of 1 in a 100 to 4 per 1000. The patient was aware of risks including, but not limited to, heart, lung, anesthesia complication, thromboembolic complications, infection, pain, bleeding, as well as injury to the internal organs such as the bowel, bladder, blood vessels, nerves, ureters, kidneys, and pelvic organs.
The patient was placed supinely on the operating room table. The patient was frog-legged, and the perineum was prepped and the bladder was straight catheterized. The abdomen was then prepped and draped in standard fashion with the patient repositioned supinely. With forceps, the skin was tested to ensure an adequate anesthetic level. The umbilical region was infiltrated with a few milliliters of 0.5% Marcaine and epinephrine solution. With a #15 scalpel blade, a small curvilinear umbilical incision was made. Dissection was carried down through the subcutaneous tissues and fascia with Metzenbaum scissors. The peritoneum was elevated and carefully entered with Metzenbaum scissors. Small retractors were placed into the incision.
Initially, the right fallopian tube was identified. It was grasped and elevated up into the operative field out of the peritoneal cavity. It was traced until fimbriated portion was identified. A knuckle of tube in the mid segment was then elevated. A hemostat was passed in the avascular portion of the mesosalpinx, through which were brought two ligatures of 0 chromic catgut. The tube was doubly ligated with the ligatures placed approximately 1 cm apart. The intervening portion of the tube was sharply excised and sent to Pathology for analysis. Electrocautery was then placed for hemostasis to the mesosalpinx and each side of the cut tube. The tube was replaced back into the peritoneal cavity after inspection revealed hemostasis. An identical procedure was then performed on the left tube. Again, two ligatures were placed and a segment of tube was excised.
Both fallopian tubes were reinspected to assure hemostasis prior to closure of the incision. The peritoneum was closed with a pursestring suture of 2-0 Vicryl. The fascia was closed with interrupted 2-0 Vicryl sutures. The skin was closed with subcuticular suture of 4-0 Vicryl followed by closure solution. The patient was moved to the recovery area in stable condition. Instruments, sponge and needle counts were reported as correct. Minimal blood loss. There were no complications.
