POSTOPERATIVE
DIAGNOSIS: Previous cesarean section, desires repeat
with adhesions.
PROCEDURE:
Repeat low-flap cesarean section and lysis of adhesions.
FINDINGS: A
live female infant with Apgars of 9 and 9.
The baby weighed 8 pounds even.
There were normal tubes and ovaries bilaterally, and there was a thick
scar of the bladder and uterus to the anterior abdominal wall.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: 800 mL.
PROCEDURE IN DETAIL: The patient was brought to the Operating Room
where anesthesia was obtained without difficulty. She was prepped and draped in a normal
sterile fashion in dorsal supine position with a leftward tilt. A
Pfannenstiel skin incision was made with a scalpel and carried through the
underlying layer of fascia with blunt and sharp dissection. The fascia was nicked on either side of the
midline. The incision was extended laterally
with the curved Mayo scissors. Inferior
aspect of the fascial incision was grasped with the Kocher clamps and elevated
off the rectus muscles. Rectus muscles
were dissected off bluntly and sharply.
Attention was turned to the superior aspect, which in a similar fashion was dissected off bluntly and
sharply. The rectus muscles were
separated in the midline. The peritoneum
was entered sharply, and the incision was extended superiorly and inferiorly
with good visualization of the bladder.
The bladder was noted to be adherent to the uterus and to the
anterior fascial wall. Wall of the
bladder was pushed inferiorly. The
Metzenbaum scissors were used carefully to facilitate dissection of the bladder
off the uterus. A minimal bladder flap
was able to be created because of this, and this was pushed inferiorly. The uterus was then incised with the scalpel,
and the incision was extended laterally with the bandage scissors. A live female infant was delivered
atraumatically. The nose and mouth were
suctioned on the field. The cord was
clamped and cut, and the infant was handed to pediatricians who signed Apgars
of 9 and 9. The baby weighed 8
pounds. Placenta was delivered
spontaneously. The uterus was cleared of
all clots and debris, and the incision was closed with 0 chromic in a
continuous locking fashion. The incision
was noted to be hemostatic. The Bovie
cautery was used for hemostasis along the bladder and uterine edge. The gutters were cleared of all clots and
debris. The tubes and ovaries were noted
to be normal bilaterally. The uterine
incision was reinspected and noted to be hemostatic. The fascia was then closed with 1 Vicryl in a
continuous fashion. Subcutaneous tissue
was irrigated. Bovie cautery was used
for hemostasis, and the skin was closed with staples. Sponge, lap, and needle counts were correct
x2, and the patient was brought to the recovery in stable condition.
No comments:
Post a Comment