OPERATION: Open Subtotal Colectomy and Ileorectal Anastomosis
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: Gentamicin and Metronidazole
INCISION: Midline.
FINDINGS: [Previous ileostomy. Pelvic adhesions. Previous anastomotic site].
PROCEDURE:
Ileostomy mobilised and end stapled off with GIA prior to laparotomy.
Mobilisation of colon from caecum to top of rectum.
Rectum divided with GIA80 below old anastomosis.
Bowel excised with Ligasure close to bowel wall.
Ligation of ileocaecal pedicle.
Orientation of small bowel confirmed. Good length, no twists.
Head of CDH 29 gun delivered via antimesenteric border.
Stapled CDH anastomosis performed.
Negative leak test. Two good doughnuts confirmed.
CLOSURE:
Stoma site closed with interrupted mattress sutures 1 PDS.
Midline closed with looped 1 PDS using small-bite principles.
3-0 Monocryl to skin.
POST-OPERATIVE INSTRUCTIONS:
Nasogastric tube on free drainage. Comfort sips.
Continue parenteral nutrition. No further antibiotics. Dalteparin as usual.