OPERATIVE REPORT
Service: Surgery Ward__ Sex: Female
Age:62 Race: Black
Date: 01/15/91
Surgeon: Z.
Alterman, MD
Assistant: R. Hand, MD
Anesthesiologist: Bo Peep,
MD
Name of Operation: Abd.
Expl. - Distal gastrectomy - Gastroduodenostomy
Anesthesia: General
Pre-Operative Diagnosis: Carcinoma
of the stomach
Post-Operative Diagnosis: Carcinoma
of the stomach with metastasis to liver
Operation Started: 11:15
am
Operation Ended: 1:55 pm
Patient Name: Ann
Trum Record
Number: 000035
CLINICAL HISTORY:
This 62 year-old black female had been worked up
by medicine for masses in the epigastrium. A liver
scan revealed multiple filling defects and an upper
GI series revealed an antral lesion which was obstructing
the fundus of the stomach.
OPERATIVE FINDINGS:
Under general anesthesia, with the patient in the
supine position, the abdomen was prepped and draped
in the usual fashion. An upper midline incision was
made and the peritoneal cavity entered. Generalized
abdominal exploration revealed multiple large nodules
within the substance of both lobes of the liver and
a large ulcerating lesion in area of the antrum of
the stomach. Multiple nodes along the lesser and greater
curvature of the stomach and the subpyloric area were
positive clinically for tumor. The stomach was not
adherent to the pancreas or any other structures,
therefore, a distal gastrectomy was undertaken. The
greater and lesser curvatures of the stomach were
freed up as was the duodenum, and Payr clamps were
placed along the distal stomach just beyond the pylorus,
and the distal stump was amputated.
PROCEDURE CONTINUED:
This was reflected up and the left gastric arteries
were ligated. The stomach was then transected in the
usual fashion and the greater curvature tapered using
a 2-0 chromic and an inverting suture of 2-0 silk.
The distal lumen was free of tumor and this was then
anastomosed in 2-layer fashion to the proximal duodenum
using an inner running suture of 3-0 chromic and an
outer interrupted of 3-0 silk. Estimated blood loss
during the procedure was approximately 300 cc's. The
sponge counts at the conclusion of the procedure were
correct.
The abdomen was closed with nylon retentions and
midline sutures of zero-silk. The skin was closed
with interrupted 4-0 silk. The patient tolerated the
procedure well, however, a period of Cheyne-Stokes
respiration followed the conclusion of the case and
the endotracheal tube was allowed to remain in, and
the patient was placed on a Byrd Respirator in the
recovery room. Other than this, the case went smoothly
and the patient did well.
Surgeon: Z. Alterman, MD
Date:
01/15/91
Date dictated: 01/15/91 Date
transcribed: 01/18/91
Patient Name: Ann Trum
Record
Number: 000035