Monday, September 28, 2009
Chronicle of 9/28/09
We did 3 cases today. The first was an ileostomy takedown. I always enjoy these cases because the patients are so excited about getting rid of their ileostomy. This patient was no exception. She was so excited that she would be able to go to the bathroom normally again. Her enthusiasm was contagious. The case proceeded without a hitch and she should be going home in about 3 days.
Our second case was a small bowel resection. The patient had a small tumor in the ileum. The chief resident performed most of the procedure with a 2nd year resident assisting and with Dr K. standing by, but not scrubbed in for most of the procedure. Dr. K. did scrub in for the actual resection, then broke scrub for the residents to close. Again, a smooth case. You have to love days like this.
The third case was the big one, a completion proctectomy with formation of a "J" pouch and an anal anastomosis. With this case, too, the patients are excited to get rid of their ostomy. This case is more involved than the ileostomy takedown as the anastomosis is in the pelvis. The patient has had a total colectomy previously. Now the remainder of the rectum is removed, a portion of the small bowel is taken down into the pelvis and a "J" pouch is formed. The "anvil" portion of an end-to-end stapler is placed in the end of the pouch and secured with a purse-string stitch. The remaining portion of the stapler is inserted through the anus and the two pieces are reassembled and the stapler is fired. The stapler is then removed from the anus and the "anastomotic rings" are checked to make sure they are complete. If they do make complete rings, the patient will have to have a diverting ostomy until the anastomosis heals. This patient didn't need that - good rings!
I feel really good about the day- made three patients happy and Dr. K., too. We had great turnovers even though only two ORA's showed up for work today. It seemed that when we needed to turn over the room, they were on the floors getting patients. Two ORA's for 16 rooms just isn't a good thing. We made it through the day despite it all.