Laparoscopic appendectomy
PREOPERATIVE DIAGNOSIS
Acute appendicitis.
POSTOPERATIVE DIAGNOSIS
Acute appendicitis.
PROCEDURE
Laparoscopic appendectomy.
ANESTHESIA
General.
ESTIMATED BLOOD LOSS
5 mL.
COMPLICATIONS
None.
SPECIMEN
Appendix.
DISPOSITION
To PACU in stable condition.
OPERATIVE NOTE
The patient was brought to the operative suite, placed supine on the operating room table. After adequate general anesthesia had been achieved, the abdomen was prepped and draped in usual sterile fashion. Then, using 15 blade, an infraumbilical curvilinear incision was made. The fascia was incised. The Hasson trocar was inserted to the abdomen. The abdomen was then insufflated with CO2 to create a pneumoperitoneum and two additional 5 mm trocars were inserted to the abdomen under direct visualization, one in the suprapubic region, one in left lower quadrant. As this was completed, the appendix was visualized and noted to be markedly inflamed and edematous and stuck along the right pericolic gutter. This was mobilized by blunt dissection and there was noted to be a significant amount of reaction and phlegmon in the region. The mesoappendix was identified and ligated with Sonicision. Then, the base of the appendix was divided at the level of the cecum using Endo-GIA stapler. Then, the area was then copiously irrigated with normal saline and a 10-French JP drain was introduced and placed alongside the cecum and staple line. The appendix was then placed in an Endopouch and removed through umbilical port. The pneumoperitoneum was then released. The fascia at the umbilicus was closed with 0 Vicryl suture in interrupted figure-of-eight fashion. The skin incisions were then closed with 4-0 Vicryl in subcuticular fashion. Dermabond dressings were applied. The needle, sponge, and instrument counts were correct at the end of the case. The patient tolerated the procedure well and was then transferred to the PACU in stable condition.
Acute appendicitis.
POSTOPERATIVE DIAGNOSIS
Acute appendicitis.
PROCEDURE
Laparoscopic appendectomy.
ANESTHESIA
General.
ESTIMATED BLOOD LOSS
5 mL.
COMPLICATIONS
None.
SPECIMEN
Appendix.
DISPOSITION
To PACU in stable condition.
OPERATIVE NOTE
The patient was brought to the operative suite, placed supine on the operating room table. After adequate general anesthesia had been achieved, the abdomen was prepped and draped in usual sterile fashion. Then, using 15 blade, an infraumbilical curvilinear incision was made. The fascia was incised. The Hasson trocar was inserted to the abdomen. The abdomen was then insufflated with CO2 to create a pneumoperitoneum and two additional 5 mm trocars were inserted to the abdomen under direct visualization, one in the suprapubic region, one in left lower quadrant. As this was completed, the appendix was visualized and noted to be markedly inflamed and edematous and stuck along the right pericolic gutter. This was mobilized by blunt dissection and there was noted to be a significant amount of reaction and phlegmon in the region. The mesoappendix was identified and ligated with Sonicision. Then, the base of the appendix was divided at the level of the cecum using Endo-GIA stapler. Then, the area was then copiously irrigated with normal saline and a 10-French JP drain was introduced and placed alongside the cecum and staple line. The appendix was then placed in an Endopouch and removed through umbilical port. The pneumoperitoneum was then released. The fascia at the umbilicus was closed with 0 Vicryl suture in interrupted figure-of-eight fashion. The skin incisions were then closed with 4-0 Vicryl in subcuticular fashion. Dermabond dressings were applied. The needle, sponge, and instrument counts were correct at the end of the case. The patient tolerated the procedure well and was then transferred to the PACU in stable condition.
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