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Operative Report Essay

PROCEDURE IN DETAIL: The patient was prepped and draped in the usual manner and placed under adequate general anesthesia. A Pfannenstiel incision was performed and carried thru skin, and subcutaneous tissue, fascia, and the peritoneum. The peritoneal cavity was entered. The hemoperitoneum was noted, and approxiamately 500 mL of blood was rapidly evacuated from the pelvic cavity, as were large clots following this, the bowel was packed away from the pelvic area with packing laps. (Continued)

A retaining retractor was introduced. The left fallopian tube was noted. A large tubal ectopic pregnancy was noted affecting approximately the distal half of the fallopian tube.

Following this a Heaney clamp was placed in the mesosalpinx and another curved Heaney clamp was placed in the proximal aspect of the left fallopian tube beyond the area of the ectopic pregnancy. A partial salpingectomy was then performed, removing the portion of the left fallopian tube containing the ectopic pregnancy. Heaney clamps were then replaced with suture No. 1 Vicryl. Hemostasis was checked again and no bleeding was detected. Further evacuation of blood and blood clots was then performed. The right fallopian tube was noted to be covered with adhesions both tubo-ovarian and tubo-unterine adheasions. Then the adhesions sharply lysed freeing the right fallopian tube. The hemostasis was checked again, no bleeding was detected.

Mild serosal abrasion was noted from the area where the ectopic pregnancy was apparently attached to the bowel. This was not bleeding and was very superficial. Hemostasis was checked and no bleeding was detected.

The peritoneum was then closed continuously with chromic suture. The fascia was approximated with interrupted figure-of-8 stitches of Vicryl. The skin was approximated with a staple gun.

The patient tolerated the procedure well and left the operating room in satisfactory condition. All counts were correct. Blood loss was estimated at 1,000 mL which was replaced with 2 units of type O blood while in recovery.

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