DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Sigmoid diverticulitis.
POSTOPERATIVE DIAGNOSIS: Sigmoid diverticulitis.
OPERATION PERFORMED: Sigmoid colectomy.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
SPECIMENS: Sigmoid colon.
INDICATIONS FOR OPERATION: This is a (XX)-year-old patient with sigmoid diverticulitis. She has had recent diverticular abscess with percutaneous drainage. She has chronic ongoing active diverticulitis. We recommended she undergo sigmoid colectomy. We had initially scheduled this as a laparoscopic approach; however, putting her to sleep on the table, on palpation, she had a very large inflammatory mass, which could be palpated through her generous abdominal wall. We felt that trying to perform this laparoscopically would be extremely difficult and elected to proceed with an open surgery. We discussed this with her significant other prior to the case.
DESCRIPTION OF OPERATION: The patient was brought to the OR and placed supine on the operating table. After undergoing anesthesia, her abdomen was prepped and draped in sterile fashion with DuraPrep and Ioban. The patient’s perineum was prepped with Betadine spray.
A lower vertical midline incision was made. Dissection was taken down to the fascia, which was incised with a Bovie. We entered the peritoneum and palpated her abdomen. There was a large diverticular mass in the left lower quadrant. We were able to free this off the pelvic sidewall bluntly and get below the inflammatory mass. We stapled across the proximal rectum with the GIA-60 stapler. The mesentery was taken, working back up proximally with Harmonic scalpel until we got up above the diverticulitis. We transected the descending colon there with the same stapler. We had to mobilize splenic flexure to get the bowel down for tension-free anastomosis. This was taken down bluntly and with Bovie. Vessels were sealed with Harmonic scalpel.
Once we got the splenic flexure down, we were able to bring the descending colon in end-to-end fashion to the rectum without any tension. A 25 EEA stapler was used in the descending colon. We tried to size it up larger, but the colon was pretty small and contracted. Anvil was placed in the descending colon with the pursestring securing it. End-to-end stapled anastomosis was created. We tested the sigmoid with air and got a few air bubbles. Both mucosal donuts were intact. We oversewed the entire staple line with 3-0 silk Lembert stitches.
We copiously irrigated out the pelvis, closed the mesenteric defect with 2-0 silks. Fascia was then closed with #1 running PDS sutures. Staples were used to close the skin. The patient was awakened and transferred to PACU in satisfactory condition. The patient tolerated the procedure well.
