Views : 1340 |
Video Type: Surgical Video |
Duration: 07:54 |
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Publish: 18/09/2014
Lap. Cystojejunostomy for Pancreatic Pseudocyst
Dr. Sanjiv Haribhakti
Operative Findings:
Large pseuodcyst of pancreas
Approached from infracolic compartment
Fluid with dirty old necrotic material inside
Fluid sent for R/M and C/S
Adhesions,more in supracolic compartment, with multiple saponification spots in omentum,mesocolon and peritoneum
Operative Steps:
Position supine
Anesthesia general
Painting with povidone iodine
Access by closed method-Verres needle insertion at supraumbilical region
Pneumoperitoneum created and 10 mm port inserted
10 mm 30 degree scope inserted
5 mm ports inserted under vision in right and left subcostal and right and left lumbar region at midclavicular line under vision, of ther both lumbar ports were converted to 10 mm size later during surgery as required
Adhesiolysis done
Cyst identified from infracolic compartment, aspirated and 3 cm wide opening made with ultrasonic shears
Necrotic material removed and kept in endobag.
Roux-en-y jejunal loop created with firing of 45 mm EndoGIA stapler of Blue caliber 30 cm distal to duodenojejunal flexure
Distal limb anastomosed with cyst in single layer interrupted stitches of Vicryl 2-0
Jejuno-jejunal anastomosis done with firing of 45 mm EndoGIA stapler and defect of entry closed with continuous fashion with Vicryl 2-0
Hemostasis achieved
32 FG drain placed in left subhepatic space
Mop,gauze and instrument count confirmed
Abdomen deflated
10 mm port sites sheath closed with port vicryl
Skin closed with ethilon 3-0
Dressing done