VAC Change & Abdomen Exploration

THE NEW YORK HOSPITAL MEDICAL CENTER of QUEENS
OPERATIVE REPORT

NAME: KO, KANG WEI
MRN: 3197633
SURGEON: ADAM ROSENSTOCK, MD
DATE: 04/23/2012
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ASSISTANT: Ambujakshan Dildeep, MD

PREOPERATIVE DIAGNOSIS: Open abdomen status post exploratory laparotomy.

POSTOPERATIVE DIAGNOSIS: Open Abdomen.

OPERATION: Abdominal exploration and changing of ABThera wound VAC.

ANESTHESIA: General Endotracheal.
COMPLICATIONS: None.
SPONGE, NEEDLE, AND INSTRUMENT COUNTS: Correct at the end of the case.
DISPOSITION: Stable, intubated to the surgical intensive care unit.

INDICATIONS: The patient is a 35-year-old male who was previously operated on five days ago for upper GI bleed status post Roux-en-Y gastric bypass. The patient was left in discontinuity due to his hemodynamic instability and an open abdomen via ABThera VAC was placed. Two days prior, the ABThera was changed in the operating room and this morning the small bowel appeared to be protruding around the inner portion of the ABThera VAC. Since there was a concern that the small bowel was in direct contact with the outer foam of the VAC machine, the decision was made to take the patient to the operation room for an exploration and change of this VAC.

PROCEDURE: The patient was taken to the operating room and the procedure was performed on his surgical ICU bed. He was placed supine. Venodyne stockings were in place and cardiopulmonary monitoring was applied by anesthesia. The patient was already intubated and a Foley catheter was in place. Anesthesia was induced and the abdomen was prepped and draped in the usual sterile fashion.  An appropriate time out procedure was performed.

The ABThera seal was removed and the abdomen was again fully prepped with Betadine at this time.  Once the VAC was removed, the small bowel was inspected and no injuries were noted.  All four quadrants of the abdomen were inspected.  There was no blood, minimal fluid, and no pus. There were a small amount of adhesions to the left lateral trocar site and these were left in place.

An ABThera VAC was then reapplied being sure to ensure that the small bowel was completely covered in both the right and left gutters as well as in the pelvis.  The VAC was hooked up to the vacuum canister and suction was applied.  Suction was excellent at 125mmHg.

Sponge, needle, and instrument counts were correct at the end of the case. The patient was taken intubated in stable condition back to the surgical ICU.

ADAM ROSENSTOCK, MD

DICT: AR 04/25/2012
TRANS: ST/DLA 04/25/2012
JOB: 891423
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Digitally signed on 4/25/2012 at 2:11:17 PM by Adam Rosenstock.