Anderson Hospital 6800 State Route 162 Maryville, IL 62062 Operative Note SignedPatient: Towell,Alexnder R MR#: M000499848 DOB: 08/04/1975 Acct:V00003676858Age: 48 ADM Date: 07/01/24 Loc: ANHSURGERY Attending Dr: Pei Chang Chung M.D.cc: Chung, Pei Chang MD; Suthan***, Nanthini MD~Procedure Note - DetailedDate of Procedure07/01/24Pre-op Diagnosissmall bowel cancerPost-op DiagnosisSameProcedure Performedhand assisted laparoscopic right colectomy c mobilization of hepatic flexureSurgeonPei Chang Chung, MDAnesthesiaGeneralIndications 48-year-old male presenting with adenocarcinoma of the terminal ileum. The patient has previous sigmoid colon cancer status post resection and adjuvant therapy.Findingspalpable mass in terminal ileum with noted masses in the mesentery consistent with lymph node spreadDescription of ProcedureThe patient was taken to the operating room and placed in the supine position. After adequate induction of general anesthesia, the patient was prepped and draped normal sterile fashion. A time-out was then done to verify the patient'sidentity as well as the procedure being performed. I began by making a hand port incision around the umbilicus. Of note, this was done through his previoushand port incision. This was carried down into the peritoneal cavity and there was noted adhesions to the lower anterior abdominal wall. These adhesions weretaken down under visualization with the bovie cautery. Once the abdominal wall was cleared, the hand port was then placed. I then insufflated the abdomen through the hand port. I then placed the camera through the hand port and under direct visualization, I placed 2 5 mm ports in right lower and right mid abdomen. Once this was done, I examined the right abdomen. It was noted that the patient had adhesions of the cecum and distal ileum to the pelvis. These adhesions were taken down both bluntly and with the ligasure under direct visualization. This adhesiolysis took approximately 30 minutes. There was a noted large mass in the terminal ileum approximately 5-10 cm from the ileocecal valve. There was also noted to be at least 2 large masses in the mesentery around this area consistent with lymph node spread. I then began my medial to lateral approach. I was able to identify the right colic vessels. I subsequently transected the right colic vessels with the LigaSure device. This was taken down near the base of the mesentery with the LigaSure. Once this was done, I carried this plane towards the hepatic flexure until I encountered the duodenum which was mobilized posteriorly. I then began taking down the lateral attachments of the terminal ileum and right colon including taking down the white line of Toldt and the hepatic flexure. Once this was done my medial and lateral dissection planes met. I was able to easily manipulate the right colon. at this point I extracorporealyzed the right colon and terminal ileum. I thentransected the terminal ileum approximately 10 cm proximal to the mass with a 55GIA stapler. I then transected the colon at the ascending colon making sure there was plenty of distal intestine to the mass. I then performed a side-to-side functional end-to-end anastomosis between the ileum and ascending colon with a 55 GIA stapler followed by a TL 60 stapler. The anastomosis was noted to be tension-free and widely patent. I closed the messenteric defect with a 2.0 silk suture. I then copiously irrigated the abdomen, no other pathology was noted. I then closed the hand port incision with a 0 PDS suture at the fascial level. The skin was closed with 4 O Monocryl subcuticular sutures including the 5 mm ports sites. Dermabond was then placed on all wounds. The patient tolerated the procedure well. He was extubated in the operating room postoperatively and will be transferred to the recovery room in stable condition.Estimated Blood Loss25DrainsNoPackingNoPathologyYesComplicationsNo immediate complicationsConditionStableDispositionPACUAMG BillingSurgery - Charge Forward: Surgery BillingThis report may have been done utilizing a voice recognition system. Attempts have been made to correct errors. However, there may be uncorrected grammatical,spelling, and recognition errors present.Report Initialized date/time: Chung, Pei Chang MD 07/01/24 / 1548Electronically signed by: Chung, Pei Chang MD 07/01/24 1548

Home / Medical / Anderson Hospital 6800 State Route 162 Maryville, IL 62062 Operative Note SignedPatient: Towell,Alexnder R MR#: M000499848 DOB: 08/04/1975 Acct:V00003676858Age: 48 ADM Date: 07/01/24 Loc: ANHSURGERY Attending Dr: Pei Chang Chung M.D.cc: Chung, Pei Chang MD; Suthan***, Nanthini MD~Procedure Note - DetailedDate of Procedure07/01/24Pre-op Diagnosissmall bowel cancerPost-op DiagnosisSameProcedure Performedhand assisted laparoscopic right colectomy c mobilization of hepatic flexureSurgeonPei Chang Chung, MDAnesthesiaGeneralIndications 48-year-old male presenting with adenocarcinoma of the terminal ileum. The patient has previous sigmoid colon cancer status post resection and adjuvant therapy.Findingspalpable mass in terminal ileum with noted masses in the mesentery consistent with lymph node spreadDescription of ProcedureThe patient was taken to the operating room and placed in the supine position. After adequate induction of general anesthesia, the patient was prepped and draped normal sterile fashion. A time-out was then done to verify the patient'sidentity as well as the procedure being performed. I began by making a hand port incision around the umbilicus. Of note, this was done through his previoushand port incision. This was carried down into the peritoneal cavity and there was noted adhesions to the lower anterior abdominal wall. These adhesions weretaken down under visualization with the bovie cautery. Once the abdominal wall was cleared, the hand port was then placed. I then insufflated the abdomen through the hand port. I then placed the camera through the hand port and under direct visualization, I placed 2 5 mm ports in right lower and right mid abdomen. Once this was done, I examined the right abdomen. It was noted that the patient had adhesions of the cecum and distal ileum to the pelvis. These adhesions were taken down both bluntly and with the ligasure under direct visualization. This adhesiolysis took approximately 30 minutes. There was a noted large mass in the terminal ileum approximately 5-10 cm from the ileocecal valve. There was also noted to be at least 2 large masses in the mesentery around this area consistent with lymph node spread. I then began my medial to lateral approach. I was able to identify the right colic vessels. I subsequently transected the right colic vessels with the LigaSure device. This was taken down near the base of the mesentery with the LigaSure. Once this was done, I carried this plane towards the hepatic flexure until I encountered the duodenum which was mobilized posteriorly. I then began taking down the lateral attachments of the terminal ileum and right colon including taking down the white line of Toldt and the hepatic flexure. Once this was done my medial and lateral dissection planes met. I was able to easily manipulate the right colon. at this point I extracorporealyzed the right colon and terminal ileum. I thentransected the terminal ileum approximately 10 cm proximal to the mass with a 55GIA stapler. I then transected the colon at the ascending colon making sure there was plenty of distal intestine to the mass. I then performed a side-to-side functional end-to-end anastomosis between the ileum and ascending colon with a 55 GIA stapler followed by a TL 60 stapler. The anastomosis was noted to be tension-free and widely patent. I closed the messenteric defect with a 2.0 silk suture. I then copiously irrigated the abdomen, no other pathology was noted. I then closed the hand port incision with a 0 PDS suture at the fascial level. The skin was closed with 4 O Monocryl subcuticular sutures including the 5 mm ports sites. Dermabond was then placed on all wounds. The patient tolerated the procedure well. He was extubated in the operating room postoperatively and will be transferred to the recovery room in stable condition.Estimated Blood Loss25DrainsNoPackingNoPathologyYesComplicationsNo immediate complicationsConditionStableDispositionPACUAMG BillingSurgery - Charge Forward: Surgery BillingThis report may have been done utilizing a voice recognition system. Attempts have been made to correct errors. However, there may be uncorrected grammatical,spelling, and recognition errors present.Report Initialized date/time: Chung, Pei Chang MD 07/01/24 / 1548Electronically signed by: Chung, Pei Chang MD 07/01/24 1548