Recto-sigmoid anastomosis performed using EEA stapler 33.

Two donut tissue rings

identified. Anastomosis checked with insufllation of air through rectum. No air leak
identified.

Preop prep of rectum with digital lavage of stool followed by betadine.

Pt. prepped draped in usual sterile surgical fashion. Abdoen explored in all 4
quadrants. Bowel was examined starting from ligament of trietz to proximal stump
of sigmoid from previous resection. Both proximal and distal stump noted, tissues
appeared healthy and viable, and decision to continue to anastomosis made.
Attention to pelvis at this time. Distal stump with prolene stay sutures noted. Metal
dilators used starting with smallest dilator begain transanally. 2 more dilators,
which were bigger in size respectively, used at this time.
Once rectum dilated, previous staple line excisced and hand sewen purs string
suture done using 2-0 prolene suture. At this time, a cork was placed in the
enterotomy where previous staple line was, and tied down using the hand sewed
purs string suture.
At this time, transanal EEa was passed and opened up until screw portion of EEA
was seen. No tension on sigmoid portion was noted. Stay sutures removed. Cork
connected to screw fixator on EEA stapler and subsequently fired. Next EEA stapler
was moved out of rectum, and 2 donut tissue rings identified. Subsequently
anastomosis was checked with insuflation of air through rectum. No air leak
identified.
Decision was made to close fascia now, which was carried out using 2 zero looped
PDS sutures in standard fashion. Skin was packed with iodoform packing and
stapled in between
Pt. tolerated procedure well. Taken back to ICU for further medical management in
stable surgical condition.
Dr. Cockburn present for entire case. 814802 job ID
V00711001