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IIiomesenteric bypass graft with vein

Lisa Posted Tue 08th of October, 2013 15:05:24 PM

I need help with following op-note. The patient had a previous colon resection with worsening abdominal pain:
Dr. B. reopened the retention sutures to evaluate the bowel, which appeared viable. At this point we took over the extent of the operation and made a completion laparotomy from the mid xiphoid all the way down to the pubis. We set up our Omni tract and Balfour and retracted the mesocolon and transversed colon superiorly and our small bowel to the right and packed it off in the upper quadrant. We then identified our common iliac artery. In the process of trying to
pass vessel loops, we did make a small hole in the common iliac vein which required repair. kOnce that was accomplished, we then harvcested our greater saphenous vein for sufficient length. At that point we had 5000 units of intravenous heparin allowed to circulate 2 minutes. Then we controlled our common iliac artery, made an arteriotomy with a # 11 blade and exgtened with Potts scissors. We spatualated our graft and completed our anastomosis with 5-0 Prolene in the usual running manner. At this point, in-flow was established and there was excellent pulsatile flow noted through the graft.
We clamped with a bulldog, we then made a gentle C-loop and laid our graft in a configuration without kinking to approach antegrade onto the jejunal branch of the superior mesenteric artery. We controlled ith with Yasargil clips, made an arteriotomy with a #11 blade and exgtended with Potts scissors. We then cut our graft to the appropriate length and spatulated it and completed our anastomosis with 6-0 Prolene in the usual manner. The ususal flushing mechanisms were undertaken prior to the last knot. Clamps were released and flow was established with excellent doppler signal. (all closings were noted in op note)

SuperCoder Answered Wed 09th of October, 2013 14:30:28 PM

Please contact Manney at 866-228-9252 Extn : 4165

Thanks

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