DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Desmoid tumor of abdominal wall.
POSTOPERATIVE DIAGNOSIS: Desmoid tumor of abdominal wall.
OPERATION PERFORMED: Excision of desmoid tumor of left rectus muscle with primary repair of rectus sheath with mesh.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Minimal.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old who, in the last couple of months, began noticing a lump in the left upper abdomen and was seen in the office. A biopsy was performed under ultrasound guidance, confirming the presence of a desmoid tumor. It was not consistent with a sarcoma, and therefore, the patient comes in now for excision of this tumor, which measures around 4 to 5 cm clinically in greatest dimension. It is located in the middle of the rectus sheath, between the costal margin and the umbilicus on the left side.
DESCRIPTION OF PROCEDURE: With the patient under general anesthesia, the abdomen was prepped with ChloraPrep and draped. Marcaine 0.25% with epinephrine was used for local anesthesia. The dissection was carried down through the subcutaneous tissues with electrocautery and down to the rectus sheath.
The mass was easily palpable at this point, bulging through the rectus sheath but not growing through it. The anterior surface of the rectus sheath was cleared off of any subcutaneous tissues and the sheath was then incised in sort of an elliptical excision that encompassed the tissues overlying the tumor.
Next, electrocautery was used to cut through the rectus muscle itself, again staying wide of the tumor at all spots. The tumor was extending through the entire muscle layer, down to the posterior rectus sheath.
Therefore, the peritoneum was entered and the peritoneum was excised in the back portion of this tumor along with the posterior rectus sheath. Once the tumor was removed, it was oriented and sent to pathology for permanent exam as well as for tumor markers of estrogen.
The posterior rectus sheath was then closed with running 0 Vicryl suture and this came together easily, as it was quite distensible. The anterior rectus sheath, however, could not be closed primarily and therefore a Prolene mattress brought to the field, 3 x 6 mesh. It was trimmed to conform to the fascial defect, made slightly smaller so that the sheath would be under slight tension. The mesh was sewn in with running 2-0 Prolene sutures.
Once this was finished, a 15 Blake JP drain was placed and exited out of the anterior abdominal wall just inferior to the incision. The drain was fixed to the skin with 3-0 nylon. The skin incision was then closed with 2-0 Vicryl for the deeper layers of the subcutaneous, including Scarpa’s layer, and then interrupted and running 3-0 Vicryl subcuticular with a final closure of Dermabond.
The patient tolerated the procedure well. There was minimal blood loss. The patient was awakened from the anesthetic, extubated in the operating room and then transferred to the recovery in stable condition. Sponge and needle counts were correct.
