Wound Debridement

Operative Note Summary

Patient:  Kang Wei Ko
MRN:  2492702
Encounter Date:  Oct 05, 2012

Operative Note:
PT NAME:  KANG WEI KO
MRN:  100554653

SURGEON MD#:
SURGEON NAME:  Alfons Pomp, MD [PO089]

PROCEDURE DATE:  10/5/2012

ADMIT DATE: 9/21/2012

PREOPERATIVE DIAGNOSIS: Open, infected wound with enterocutaneous fistula

POSTOPERATIVE DIAGNOSIS:  Same

OPERATION: Wound debridement

ATTENDING SURGEON:  Alfons Pomp, MD [PO089]

The patient is a 35 yo male with history of morbid obesity and laparoscopic Roux-en-Y Gastric Bypass in March 2012. Postoperatively he had recurrent episodes of marginal ulcers with gastrointestinal bleeding. He required emergency laparotomy and revision of gastrojejunostomy at an outside hospital in May 2012 where he underwent laparotomy with resection of gastro-jejunostomy and partial resection of gastric remnant. Gastrointestinal anatomy was left in discontinuity and the abdomen was left open due to edematous bowel. He was then transferred to WCMC where he underwent abdominal exploration and washout with placement of feeding jejunostomy and cervical esophagostomy. After an prolonged period of recovery and significant weight loss on 9/21/2012 he underwent esophagogastric-jejunal anastomosis and reconstruction of Roux-en-Y gastric bypass and advancement flaps to close the abdomen: the wound was left open. The post-operative course has been notable for an enterocutaneous fistula likely from an anastomotic leak and Dr Stiles performed upper endoscopy today with insertion of a covered stent. He has a wound "VAC" in place and we obtained consent to change the VAC device while under anesthesia.

PROCEDURE: The patient entered the operating room.  Following appropriate identification, he was placed in supine position on the operating table. Venodyne boots were applied.  Full general anesthesia was induced with orotracheal intubation. Dr. Stiles completed his procedure (separate operative report).

The VAC was removed. There was a significant amount of devitalized tissue in the wound which was sharply debrided. (total surface debrided 40 square cm)

The operative site was examined and hemostasis was verified.  The wound was irrigated copiously with saline.  With this being satisfactory, The VAC was applied, white foam/black foam and then the clear plastic dressing

Anesthesia was well tolerated.  The patient was extubated on the table and accompanied by the surgical team to the recovery room.  Estimated blood loss was approximately 25cc. Sponge, needle and instrument counts were reported correct to the surgeon.

I was present during the entire procedure.

Alfons Pomp, MD, FACS

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Note electronically signed by  Alfons Pomp on Sat Oct 6, 2012  1:34 PM