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pyeloplasty

The document details a surgical procedure for a patient diagnosed with left Pelvi-Ureteric Junction Obstruction, performed by Dr. Pradeep Tenginkai. The procedure involved a dismembered Anderson Hyne’s pyeloplasty under general anesthesia, with complications leading to a transition to open pyeloplasty. Post-operative orders include monitoring and care instructions for the patient in recovery.

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4 views

pyeloplasty

The document details a surgical procedure for a patient diagnosed with left Pelvi-Ureteric Junction Obstruction, performed by Dr. Pradeep Tenginkai. The procedure involved a dismembered Anderson Hyne’s pyeloplasty under general anesthesia, with complications leading to a transition to open pyeloplasty. Post-operative orders include monitoring and care instructions for the patient in recovery.

Uploaded by

tenginkai
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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22-02-2024

Pre & Post -op Diagnosis: Left Pelvi-Ureteric Junction Obstruction


Procedure: Dismembered Anderson Hyne’s Pyeloplasty
Surgeon: Dr Pradeep Tenginkai Anaesthetist: Dr. Neeraja Dipali
Scrub Nurse: Ms.Vaani OT Technician: Mr.Ramanna

- Under General Anaesthesia, patient in low lithotomy position parts painted & draped.
- 6Fr ureteroscope revealed normal urethral mucosa, calibre. Normal bladder neck & interior.
- Scope couldn’t accommodate beyond left intramural ureter, hence 0.018 Terumo guide wire
left in situ.
- 5Fr ureteric catheterised over guide wire, RGP revealed narrow upper ureter & PUJ with
global caliectasis. 8Fr Foley’s catheterized, bladder drained & catheter kept clamped.
- Patient placed in right lateral position, pressure points cushioned. Extremities, trunk
supported with soft bolsters. Kidney bridge raised.
- Left loin painted, 10mm port placed superolateral to umbilicus, two 5mm ports in upper &
lower quadrants of midclavicular line.
- Pneumoperitoneum created & dissection started to mobilize descending colon up to splenic
flexure.
- Ureter identified, mobilized up to PUJ. Evidence of crossing vessel seen.
- Dissection continued at PUJ – dilated pelvis with narrow PUJ noted.
- Ureter dismembered below renal pelvis & brought out of crossing vessel. Narrow ureter was
transected up to normal proximal ureter.
- Pelvis cut horizontally around 100ml clear urine drained. Ureter spatulated on its lateral
wall.
- Antegrade DJ stenting over 0.018 guide wire confirmed patency of entire ureter.
- Anastomosis of spatulated ureter with renal pelvis begun, but suture gave away at multiple
sites resulting in jeopardized approximation.
- Hence open pyeloplasty was begun. Ureter was anastomosed to renal pelvis over 3.5Fr DJ
stent interruptedly.
- Catheter clamp released, kidney bridge released & 14Fr suction tube kept as drain. Drain
secured to left loin with 3-0 Ethilon.
- Instruments, needle, gauze & mops count confirmed. Haemostasis & urine leak from
anastomotic site rechecked.
- Wound closed in layers: 2-0 Vicryl for muscle & aponeurosis, 3-0 Vicryl for subcutaneous
tissue & 3-0 Ethilon for skin.
- Dressing applied, patient turned back to supine, extubated successfully & shifted to
recovery room.
Post-op orders:
 Nil by mouth till further orders
 Monitor vitals Hourly
 Oxygen inhalation 2lit/min
 Input – Output chart
 Inform S-O-S

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