Esophagoscopy

NY Presbyterian Hospital - Cornell
Operative Report

Name: KO, KANG WEI
MRN: 02492702
ATT:
DICT: Brendon Stiles, M.D.
Admit Date:04/23/2012
Discharge Date:
Procedure Date:04/26/2012
SURGEON: Brendon Stiles, M.D.

CONSULTANT:
ASSISTANT:
PREOPERATIVE DIAGNOSIS: 1.  Previous gastric bypass surgery with postoperative bleeding requiring division of gastrointestinal tract now with esophagus and proximal gastric stump left in discontinuity.  2. Open abdomen.
POSTOPERATIVE DIAGNOSIS:
OPERATION: Esophagoscopy.
ANESTHESIA: General endotracheal anesthesia.
ANESTHESIOLOGIST:

BRIEF HISTORY:
Mr. Ko is a young man who is status post bariatric surgery. His postoperative course was complicated by bleeding. This was initially treated endoscopically, but he eventually required an emergency laparotomy. At that time his Roux limb was taken down and his proximal gastric stump was left in discontinuity with his GI tract. He had an NG tube placed for drainage of that. He was critically ill and eventually transferred over to our ICU. His attending physicians, Dr. Rubino and Dr. Pomp, elected to explore his abdomen. It had been left open. The patient was significantly fluid overloaded and malnourished. It was not thought that the timing was right to re-establish continuity of his GI tract. They asked me to get involved with regard to drainage of the esophagus. I recommended an EGD initially to look at the stump, then we would consider drainage options including leaving the NG tube, a tube placed through the neck, or esophageal diversion. I explained the risks and benefits of each procedure to the patient's family in detail.

DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and prepared for exploration by Dr. Pomp and Dr. Rubino. I performed an EGD first. The upper esophagus was normal. GE junction was at 42 cm. Just distal to this there was a small gastric pouch approximately 2-3 cm in length. It appeared healthy and viable. Staple line was intact. It held air well. Port lines seemed to be well drained by the indwelling NG tube that was in place. I advanced the NG tube slightly. I then removed the scope. At this time Dr. Pomp and Dr. Rubino elected for no further esophageal drainage procedures. They did not feel like they would be able to close the abdomen at this time either because of the swelling. We discussed the options of bringing him back the following week, possibly for abdominal closure and possibly for more definitive long-term drainage of his esophagus. I will largely defer to their wishes in terms of drainage. I have discussed with the family the manner of how we would deal with the esophagus. The patient is at somewhat of a risk for the gastric stump to break down. A separate OP note will be dictated by Dr. Rubino or Dr. Pomp regarding the abdominal exploration.

DD:04/27/2012
DT:04/27/2012
Job:869245
Message Control: 869245

BRENDON STILES
ELECTRONICALLY SIGNED 5/2/2012 14:14