DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Probable appendicitis.
POSTOPERATIVE DIAGNOSIS:
Gangrenous perforated appendicitis.
OPERATION PERFORMED:
Laparoscopic appendectomy and washout of abdominal cavity.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
SPECIMEN: Appendix.
ESTIMATED BLOOD LOSS: 50 mL.
DRAINS: A #10 Jackson-Pratt drain.
INDICATIONS AND DESCRIPTION OF PROCEDURE:
The patient is a (XX)-year-old male with a 1-day history of severe abdominal pain who presented to the emergency room. He had an elevated white count of 17,500 and a CT scan consistent with some periappendiceal inflammation. Exam was consistent with acute appendicitis. The patient was taken to the operating room. The patient was then placed supine on the operating table. After the general anesthesia was administered, the abdomen was prepped and draped in the standard surgical fashion. A Foley catheter was placed. An incision was carried down in the umbilicus with a 15 blade scalpel. Veress needle was introduced into the abdominal cavity. The abdominal cavity was insufflated with CO2 gas.
Next, bladeless trocar was passed into the abdominal cavity. A 10 mm scope was placed into the abdominal cavity. There was no evidence of any trauma secondary to placement of the Veress needle that was noted. There was some area of gross purulent fluid noted in the right lower quadrant and there was noted to be some stool in the right lower quadrant consistent with perforated appendicitis. A 5 mm trocar was placed in the suprapubic position under direct visualization after a small nick was made with a #15 blade. An additional 10 mm trocar was placed in the left lower quadrant in the similar fashion. The appendix was noted to be extremely friable and was difficult to grasp. It was falling apart each time it was grasped.
At this time, the terminal ileum was mobilized with the use of sharp dissection. The appendix was noted to be retrocecal and extending up towards the hepatic flexure. The colon and terminal ileum were completely mobilized. The appendix was grasped at the tip and it was noted to fall apart and it was taken out. Next, it was grasped at the cecal and its origin at the cecum. Using an Endo-GIA stapler, it was stapled off from the cecum. A bag was introduced into the cavity and the appendix was taken in piecemeal fashion and some stool was taken out as well with the bag. Following that, the mesentery of the appendix was grasped, stapled off with the use of endovascular GIA and then the area was next copiously irrigated with normal saline. There was good hemostasis. Small areas of stool and pus were irrigated out.
A #10 JP drain was placed along the right paracolic gutter extending up to the hepatic flexure and brought out through the 5 mm port site in the suprapubic position. The rest of the ports were removed. The abdomen was drained of CO2 gas. The fascia was approximated with a #1 Vicryl in a figure-of-eight fashion. Subcutaneous tissue was copiously irrigated and approximated with the 4-0 Monocryl interrupted. The areas were cleaned and dried. Benzoin was applied. Steri-Strips were applied. Dry sterile dressing was applied. The patient was awakened, extubated and transported to the recovery room in alert, awake and stable condition. All sponge and instrument counts were correct at the end of the case.
