Exploration and washout after liver transplant.

Title of Operation:

Exploration and washout after liver transplant.

Open liver biopsy.

Bile duct anastomosis with a T-tube placement and abdominal closure.

福建省立医院基本外科黄东航

Indications for Surgery:

Preoperative Diagnosis:

Status post liver transplant with open abdomen and biliary discontinuity and liver dysfunction.

Postoperative Diagnosis:

Status post liver transplant with open abdomen and biliary discontinuity and liver dysfunction.

Anesthesia:

General endotracheal.

Specimen (Bacteriological, Pathological or other):

Tru-Cut biopsy x3 as well as hematoma 4 Gram stain and culture.

Prosthetic Device/Implant:

T tube and 19-French round Blake drains x3.

Surgeons Narrative:

Operative Details:  Mr. *** is a 55-year-old gentleman about 5 days out from liver transplant.  He has had significantly early poor graft function which is slowly improving.  He had returned to the operating room once already for washout and repacking he was returned to the operating room today for washout removal packs and a biliary reconstruction.  He was taken to the operating room from the ICU intubated general anesthesia was induced and he was prepped and draped in usual sterile fashion. The previous abdominal VAC dressing was removed.  There was minimal intraperitoneal hematoma at the time of this exploration, a specimen was sent for Gram stain and cultures.  There was a fibrinous rind on small bowel and liver which was slowly washed out with copious warm sterile saline irrigation.  Hemostasis was good.  The liver appeared somewhat softer than it had at the time of previous exploration, it was still firmer than what would be ideal.  Three Tru-Cut biopsy specimens were obtained 1 from the left lobe and 2 from the right lobe.  After further get these irrigation, all intra-abdominal packs which have been left at the time of previous surgery were removed.  It was clear that there was some bilious staining to the peritoneal fluid.  The drainage tube which had been in place was still well positioned, however had not to obviously given ideal biliary drainage.  The previous tube was removed, the donor bile duct was trimmed back to healthy viable tissue, the recipient bile duct was also similarly prepared.  The bile duct anastomosis was carried out using interrupted 5-0 Maxon suture after completion of the back robe. An 8-French T-tube was placed, a 5-0 Maxon suture was placed at the exit site of the T tube from the recipient bile duct as well. The anterior row of 5-0 Maxon were then placed completing a biliary anastomosis, the T tube was tunneled out the right anterior abdominal wall, three 19-French Blake drains were placed in usual fashion. The fascia was then closed and in 2 layers with running #1 Prolene.  Skin was closed with staples as there were no appropriate residents available I was assisted by *** ***. The patient was returned to the surgical ICU in stable condition.

CLINICAL STAGE OF TUMOR:

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