Republic of the Philippines

Department of Health Regional Office No. VII

GOV. CELESTINO GALLARES MEMORIAL HOSPITAL
Miguel Parras St., Tagbilaran City, 6300, Bohol Tel.No: (038)411-4868, (038)
411-4869
Email add: gcgmh_bohol@yahoo.com.ph

OPERATIVE TECHNIQUE

NAME: DAMPOG, JENNIFER DATE: SEPTEMBER 15, 2018

AGE: 29 HOSPITAL NO: 555039-2018

PRE-OP DIAGNOSIS: G3P1 (1011) Ovarian Pregnancy, right 10 1/7 weeks Age of
Gestation

POST-OP DIAGNOSIS: G3P1 (1021) Ovarian Pregnancy, right 10 1/7 weeks Age of
Gestation, Hemoperitoneum secondary

OPERATION PERFORMED:

PELVIC LAPAROTOMY WITH RIGHT SALPINGO-OOPHORECTOMY + LAVAGE

SURGEON: DR. HEIDE TAGAB-ROMERO

FIRST ASSIST: DR. APRIL ANN ALPAS-DELA PENA
SECOND ASSIST: JUNNA SHERILEE G. BALANI-PGI

PROCEDURE:

 Patient was placed in left decubitus position and was inducted with epidural
anesthesia. The patient was then placed in supine position. Foley Catheter
(French 16) was inserted and attached to urobag.
 Patient was prepped and draped in the usual sterile manner for an abdominal
procedure.
 A midline vertical incision was made using a scalpel beginning 2 to 3 cm
above the symphysis pubis extending cephalad to within 2 cms of the
umbilicus.
 The subcutaneous layers of Camper and Scarpa were incised up to the linea
alba fascia. This fascial layer was entered sharply near the midpoint of the
incision and was extended cephalad and caudad to the full length of the skin
incision.
 The peritoneum was then grasped between 2 Kelly clamps, was elevated and
was bluntly dissected, extending cephalad and caudad.
 Retractors were placed to expose the peritoneal cavity. Abdomen was visually
and manually explored, and the bowel was packed from the operating field.
 The right infundibulopelvic ligament and the ureter were identified. An incision
was made and extended cephalad toward the pelvic brim.
 Peritoneal window was opened, blunt dissection was directed deep, cephalad,
and slightly medially through gauzy areolar connective tissue.
 The adnexa was then lifted from the pelvis and inspected. A second
peritoneal opening was sharply created with Metzenbaum scissors at the
posterior leaf of the broad ligament below the infundibulopelvic ligament but
above the ureter.
 This incision was extended medially beneath the fallopian tube and
uteroovarian ligament and toward the uterus. While remaining parallel to the
infundibulopelvic ligament, it was also extended lateral and cephalad towards
the pelvic brim.
 Infundibulopelvic ligament was isolated and was then clamped with a Heaney
clamp with the clamp’s curve facing upward. A single Kelly clamp was placed
across the infundibulopelvic ligament at 1 centimeter medial to the Heaney
clamp.
 The infundibulopelvic ligament was transected between the Heaney and Kelly
clamps with a curve Metzenbaum scissors and was then ligated using a free
tie of 0-gauge delayed absorbable suture. Next, a transfixing suture was
placed below the clamp yet distal to the first free tie and the Heaney clamp
was removed.
 With the adnexa elevated, a Heaney clamp was placed across both the
proximal uteroovarian ligament and fallopian tube with the clamp’s curve
facing the ovary. Next, another clamp was placed laterally and was directed
medially to close around the remaining mesosalpinx and mesovarium beneath
the ovary. Again, the clamp’s curve faces the ovary.
 Above both of these clamps are stacked second clamps, which lie a distance
above their partners and closer to the ovary. Tissue between the stacked
clamps was cut with electrocautery to free the adnexa.
 The freed adnexa was removed from the operative site and sent to pathology
for evaluation.
 Tissue within each of the remaining two clamps was individually suture ligated
with 0-gauge delayed-absorbable suture.
 Hemostasis was then inspected and secured throughout the entire area.
 Peritoneal washing done with PNSS until return flow was clear.
 The lap sponges and retractors were then removed.
 The left ovary and fallopian tube were inspected.
 Operative sponges, instruments and needles counted complete.
 Abdominal incision repaired layer by layer.
Peritoneum: continuous interlocking – Chromic 2-0
Fascia: simple continuous- Novosyn 0
Subcutaneous: simple continuous – Novosyn 0
Skin: subcuticular-Vicryl 3-0
 Betadine antiseptic and sterile dressing was applied over abdominal incision.
 Operation ended with patient in fair condition.
OPERATIVE FINDINGS:
On opening up, noted hemoperitoneum approximately 800cc with blood clots.
On further exploration, noted intact amniotic sac with embryo inside and enlarged
right ovary with rupture site approximately 3 cm. The uterus is slightly enlarged
retroverted with adhesions noted on the posterior aspect to the bowel. The left ovary
was not visualized but was able to palpate adherent to the left side wall. Grossly
normal fallopian tubes adherent to posterolateral aspect of the uterus.

DR.HEIDE TAGAB-ROMERO JUNNA SHERILEE BALANI

RESIDENT-IN-CHARGE POST-GRADUATE INTERN