DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Hydrocephalus.
POSTOPERATIVE DIAGNOSIS: Hydrocephalus.
OPERATION PERFORMED:
1. Left external ventricular drain removal.
2. Right ventriculoperitoneal shunt placement in 5 kg infant.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old boy with a complex medical history who presented with a ventriculoperitoneal shunt failure. The patient has now had more than a week of negative cultures and appropriate antibiotics.
The risks, benefits and alternatives of surgery were discussed with the family. The risks including, but not limited to, bleeding, infection, injury to the brain, injury to the peritoneal contents, allergic reaction to anesthesia or even death were discussed.
No guarantees were made or implied. Despite the above, they desired to proceed with the left external ventricular drain removal and right ventriculoperitoneal shunt placement.
FINDINGS AND PROCEDURE: The patient was brought to the operative suite and underwent general endotracheal anesthesia. The left frontal incision was then prepped, the staples removed and the external ventricular drain stay stitches cut. The external ventricular drain was removed and the exit site as well as the insertion site was oversewn using 4-0 Vicryl Rapide.
Attention was then turned to the right side of the patient. He was prepped and draped in the usual sterile fashion and his previous right frontal incision was reopened with blunt and sharp dissection down to the existing bur hole. A curette was used to widen the bur hole and Kerrison punch was used to make it larger as well. Shunt passer was then passed from the right frontal region to the right lateral cervical region just above his ECMO cutdown site. The Micro Codman shunt single pressure of 70 mmHg had the Bactiseal peritoneal catheter tied to the proximal end and been appropriately flushed.
It was then passed through the shunt passer and the shunt passer was passed from the right lateral cervical region to the right upper quadrant and the shunt again was passed likewise. The distal 20-30 cm of peritoneal catheter were cut off and discarded.
The dura was incised using monopolar electrocautery and the ventricular catheter was passed into a depth of approximately 16.5 cm. It was easily passed into the lateral ventricle with spontaneous flow of moderate pressure CSF. The ventricular catheter was then appropriately attached to the Rickham reservoir and sewn in place using 2-0 Vicryl. The valve system was appropriately seated in the scalp tissue and spontaneous flow of clear CSF was appreciated through the distal end of the peritoneal catheter.
With the assistance of anesthesia, getting a valve set up to 40, peritoneal trocar was passed in the peritoneal cavity. The distal end of the peritoneal catheter was then passed into the peritoneal cavity without difficulty.
Dr. Jane Doe had been on standby should entering the peritoneal cavity have caused any difficulty in this medically complicated patient with a history of a Nissen and G-tube.
The incisions were copiously irrigated with antibiotic irrigation and closed in anatomic layers using 4-0 Vicryl. The final layer of skin was closed using 4-0 Vicryl Rapide in the cranial incision and benzoin and Steri-Strips in the neck and abdominal incision.
The patient tolerated the left external ventricular drain removal and right ventriculoperitoneal shunt placement well and was sent to the PACU postoperatively.
