DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Metastatic gastric tumor.
POSTOPERATIVE DIAGNOSIS: Metastatic gastric tumor.
OPERATIONS PERFORMED:
1. Gastrostomy tube.
2. Jejunostomy tube.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
SPECIMENS: None.
INDICATIONS FOR OPERATION: This is a (XX)-year-old gentleman with metastatic gastric tumor. He has invasion into the stomach with posterior gastric perforation. We were consulted for a feeding tube. We also recommended decompressive G-tube. Risks, benefits, and alternatives have been discussed with the patient, and he has consented for surgery.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed supine on the operating table. After undergoing anesthesia, his abdomen was prepped and draped in sterile fashion with DuraPrep and Ioban.
A vertical midline incision was made. Dissection was taken down to the fascia. The fascia was incised with Bovie, and the peritoneum was entered. The small bowel was run, and ligament of Treitz was identified. At 15 cm distal to the ligament of Treitz, we made a pursestring suture on the antimesenteric border of the small intestine with 3-0 chromic. A 12-French red rubber catheter was passed into the intestine and then secured with pursestring suture. Witzel tunnel was fashioned with 3-0 silk Lemberts. The tube was brought out through the anterior abdominal wall on the left, and the small bowel was tacked to the anterior abdominal wall proximally and distally. The tube was secured with 2-0 silks. The stomach was identified and grasped with Babcock. Two 2-0 pursestring sutures were placed. A 20-French MIC tube was brought through the anterior abdominal wall and placed into the stomach. The balloon was tested and working and not leaking x2.
Both pursestrings were secured. The balloon was cinched up to the anterior abdominal wall and tacked with 2-0 silks. It was also secured to the cuff with two 2-0 silks as well. A 0 PDS runner was used to close the subcutaneous tissue and 3-0 Vicryl and 4-0 Monocryl used to close the skin. Steri-Strips were applied. Both tubes were left fully drained. The patient was awakened and transferred to PACU in satisfactory condition. The patient tolerated the procedure well.
