DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: End-stage renal disease with need for long-term dialysis access.
POSTOPERATIVE DIAGNOSIS: End-stage renal disease with need for long-term dialysis access.
OPERATION PERFORMED: Placement of a peritoneal dialysis catheter.
SURGEON: John Doe, MD
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old male who has renal failure and will need to be on dialysis. The patient desires peritoneal dialysis. He had a previous attempt at placement of the peritoneal dialysis catheter. This is now the second attempt at placement. The risks including bleeding, infection and possibility of bowel injury were explained to the patient, all questions were answered and the patient agreed to proceed.
DESCRIPTION OF OPERATION: The patient was placed on the operating room table in the supine position. General anesthetic was induced and maintained with an oral endotracheal tube. The abdomen was scrubbed and prepped with Betadine soap and solution and draped with sterile towels and drapes. He had a previous attempt at placement of the catheter through the left rectus sheath. We then outlined the skin incision on the right rectus sheath, transversely oriented and just below the umbilicus. A curvilinear incision was outlined as well with an exit site well below the umbilicus. All of these areas were then anesthetized with 1.5% of Marcaine. An incision was made and deepened down through the subcutaneous tissue. Electrocautery was used for hemostasis. The anterior rectus sheath was infiltrated and divided transversely. The muscle fibers were split in their natural direction and held apart with a small Weitlaner retractor. The posterior rectus sheath was infiltrated. Next, 2 hemostats were used to attempt the posterior rectus sheath output. A small nick was made within the posterior rectus sheath and peritoneal cavity was entered. A 2-0 Prolene suture was placed. This was a double-armed suture. A full-size swan-neck Curl Cath peritoneal hemodialysis catheter was inserted over catheter guide under fluoroscopic guidance and positioned in the deeper aspect of the pelvis on the right side, aspirated and infused through the catheter. Again, the position of the catheter was confirmed by C-arm fluoroscopy. The pursestring suture was then tied both distally and proximally to the distal cuff. Each end of the double-armed suture was then brought out through the anterior rectus sheath. The anterior rectus sheath was closed both medially and laterally with a double-armed suture with a second watertight closure being achieved. For bleeding, hemostasis was achieved. The catheter was then brought out through its tunnel and exit site. It was assembled. It was connected with a liter bag of Dianeal. One liter inflowed and then outflowed without incident. The fluid was clear on outflow. The wound was then inspected for bleeding and then closed with running 3-0 Vicryl to subcutaneous tissue with running 4-0 Vicryl subcuticular suture to the skin. Sterile bandage was applied. The patient tolerated the procedure well without complications. The final sponge, needle and instrument counts were correct and the patient left the operating room to go to recovery room in satisfactory condition.