DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. End-stage renal disease secondary to insulin-dependent diabetes mellitus.
2. Insulin-dependent diabetes mellitus.
POSTOPERATIVE DIAGNOSES:
1. End-stage renal disease secondary to insulin-dependent diabetes mellitus.
2. Insulin-dependent diabetes mellitus.
OPERATION PERFORMED: Simultaneous pancreas and kidney transplant.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old woman with end-stage diabetic nephropathy who presents for a simultaneous pancreas-kidney transplant. A suitable donor has become available.
DESCRIPTION OF OPERATION: In the operating room, the patient was placed in the supine position. General anesthesia was induced, and a triple lumen central line was placed by Anesthesia, and the area was prepped and draped. The peritoneal cavity was entered through a long midline incision. The Bookwalter retraction system was then placed. Brief survey of the abdomen revealed no abnormalities.
The left colon was mobilized along its peritoneal reflection exposing the left iliac fossa. The left external iliac artery and vein were dissected and prepared for anastomosis. Next, the right colon was mobilized along its peritoneal reflection completely mobilizing, including the hepatic flexure. The distal vena cava and the proximal right common iliac artery were then prepared for anastomosis. There was minimal plaque in the arteries.
Next, the pancreas graft was placed in the right iliac fossa with the tail towards the pelvis and the duodenal segment toward the liver. The portal vein was then anastomosed to the distal vena cava with a running 6-0 Prolene suture under the appropriate vascular control.
Next, the iliac Y-graft was shortened to the appropriate length and then anastomosed to the right common iliac artery also with a running 6-0 Prolene suture and utilizing a 4.0 aortic punch. Flow was re-established. There was excellent perfusion throughout the pancreas. Bleeders were controlled with Prolene and silk suture ties. There was good perfusion of the duodenal segment. The graft was irrigated with warm saline. There was a good pulse in the tail the pancreas. The duodenal segment was then anastomosed to the proximal jejunum about 30 cm from the ligament of Treitz forming a two-layer anastomosis with running 3-0 PDS suture. The abdomen was then irrigated with several liters of warm saline.
Next, the kidney was placed in a left iliac fossa, anastomosed to the renal vein to the left external iliac vein with a running 6-0 Prolene suture under the appropriate vascular control. The renal artery patch was then anastomosed to the left external iliac artery with a running 6-0 Prolene suture. Flow was re-established. There was excellent perfusion throughout the kidney with no ischemic areas. The ureter was then anastomosed to the left anterolateral aspect of the bladder after shortening the ureter to the appropriate length and spatulating and forming the anastomosis with a running 5-0 PDS suture. The area was irrigated and good hemostasis established.
Next, the pancreas was reinspected for bleeding and again hemostasis was good. The abdomen was again irrigated with several more liters of warm saline. Surgicel was then placed over multiple areas on the pancreas and the pancreatic anastomosis. Surgicel was placed anterior and posterior to the renal pelvis. The small bowel was run from ligament of Treitz to the ileocecal valve. The omentum was placed under the midline incision.
The incision was then closed with running #1 PDS suture with several interrupted PDS sutures to reinforce closure. The skin was stapled. Dressings were applied. The patient was then extubated and transferred to the recovery room in stable condition.
