Hellow guys, Welcome to my website, and you are watching A Different TECHNIQUE FOR BOWEL DISSECTION THROUGH PARTIAL PERITONECTOMY BY DR KHALID AKKOUR. and this vIdeo is uploaded by خالد عكور khalid akkour at 2023-01-09T00:44:49-08:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | A Different TECHNIQUE FOR BOWEL DISSECTION THROUGH PARTIAL PERITONECTOMY BY DR KHALID AKKOUR |
| Video Uploader | Video From خالد عكور khalid akkour |
| Upload Date | This Video Uploaded At 09-01-2023 08:44:49 |
| Video Discription | This is a 49 y old lady who underwent 2C/S & laparoscopic left salpingectomy for ectopic pregnancy that was converted to laparotomy due to massive bleeding. She is complaining of severe menorrhagia & intermenstrual bleeding which wosened badly with time. She dropped her Hb many times and needed multiple blood transfusions. She was Planned for Robotic hysterectomy with RSO & preservation of Left ovary. We were expecting adhesions as her Last surgery was complicated by massive bleeding and as bloody fields are the perfect fields for massive adhesions. We are ntered the abdomen through palmar’s point & we found massive bowel adhesions from that level down to the uterus. Abdominal wall was very weak & multiple loops of small and large bowel were severely adherent to abdominal wall. The adhesions were not the usual adhesions that we are used to, as they resembled multiple hernias. There were no planes to be dissected which made us think of different technique to deal with these adhesions. We had to du laparoscopic partial peritonectomy at each adhesive site which was the only option to be able to proceed with this surgery. It was an extremely difficult adhesolysis but successful. We were able afterwards to put the rest of robotic ports and go ahead with our gynecological surgery which was reasonable apart from bladder adhesions and difficult uterine arteries given the size & the high vascularity of the uterus which is mist likely adenomyotic. If we converted this case to laparotomy, we would still have to deal with the adhesions and might even go directly through the bowel & injure it. The laparoscopy enabled us to have a panoramic view and dissect with more and clearer visualization compared to laparotomy. We eventually managed to do the whole case in around 2 h. Although blood loss was. Minimal, A drain was inserted mainly to check for bowel leaks & the patient was kept in the hospital for 2 days to make sure she opens up her bowel & shows no signs of bowel injury. She did very well & the drain was dry. She was discharged on day 3 after removal of the drain in a very stable condition. She was followed by phone the following few days & was doing very well. This case shows the superiority of MIS to laparotomy even in extremely difficult cases where we classically used to do them through laparotomy thinking that it’s safer than MIS. That Myth turned to be a psychological delusion rather than a scientific fact. |
| Category | Education |
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