NY Presbyterian Hospital - Cornell
Operative Report
Name: KO, KANG WEI
MRN: 02492702
ATT:
DICT: Brendon Stiles, M.D.
Admit Date:09/21/2012
Discharge Date:
Procedure Date:10/14/2012
SURGEON: Brendon Stiles, M.D.
CONSULTANT:
ASSISTANT:
PREOPERATIVE DIAGNOSIS: Anastomotic leak status post gastrojejunostomy.
POSTOPERATIVE DIAGNOSIS: Anastomotic leak status post gastrojejunostomy.
OPERATION: Esophageal stent placement under fluoroscopic guidance.
ANESTHESIA:
ANESTHESIOLOGIST:
BRIEF HISTORY:
Mr. Ko is a patient well known to my service. He had a complicated bariatric surgery with postoperative complications requiring leaving him with discontinuity. He had recently been explored and continuity reestablished with a gastrojejunostomy. Postoperatively, he developed a small leak from this. I previously stented it placing a stent across the gastrojejunal anastomosis and well into the jejunum at the request of the primary surgeons, Dr. Pomp and Dr. Rubino. He has continued to have some output however from a wound VAC and JP drain. A swallow study suggests a very small leak proximally. I was therefore asked to take him back to the operating room to place another more proximal stent. Risks and benefits of the procedure were explained in detail to the patient. Written consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and general endotracheal anesthesia was induced. The primary team was also going to perform a wound debridement in the same setting.
I then performed an endoscopy. GIF endoscope was advanced through the patient's esophagus across the GE junction and into the gastric remnant and inserted into the gastric pouch. The stent was visualized below the GE junction. I could pass through it and into the jejunum. I then pulled back slightly more proximally and placed a wire through the current indwelling stent. It was done under live fluoroscopic guidance. The scope was then brought back and pulled out. I then advanced a stent down over the wire across the GE junction and carefully pushing it into the existing stent under direct vision with fluoroscopy. This was a 23 mm diameter x 12.5 cm long stent. I then deployed it under direct fluoroscopic guidance with the distal end in the previous stent and the proximal end in the lower esophagus. It deployed well. Endoscopy was performed afterwards to confirm position. It looked good. The bowel was ex-sufflated and the scope was removed. I was present for and performed the entire procedure.
DD:10/14/2012
DT:10/14/2012
Job:869666
Message Control: 869666
BRENDON STILES
ELECTRONICALLY SIGNED 10/26/2012 13:27
2012 - 2014 were the most difficult years of my life. In 2012, a routine gastric bypass surgery developed into life-threatening complications, several emergency surgeries, weeks spent intubated in the ICU, and months of hospital stay. It took almost 2 full years for me to recover. In 2014, I had an aortic valve replacement surgery. My chest was cracked open, my heart was stopped and put on bypass, then everything got put back together without any major issues.
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