Surgical anastomosis Puns

51f, diagnosed stage 3b in April 2021, with some lymph node involvement. 8 rounds of Folfox, 28 sessions of chemoradiation and it looks like I’ve had almost a complete response to treatment. New cancer stage is 1😀 I have resection surgery scheduled for 1/19/22. My pre-surgical consult is 12/27/21. My surgery is listed in my patient portal as “laparoscopic colectomy partial with coloproctostomy low anastomosis”. Quite a mouthful. So, temporary colostomy. I meet with the stoma nurse on 1/12/22. Are there questions I should be sure to ask the surgeon and the stoma nurse? This will be my first surgery ever other than my chest port placement.

Here is the question:

The patient is a 56-year-old male who was admitted with a history of hematemesis for the past 36 hours. He also had some tarry black stools and was noted to have a giant gastric ulcer which was actively bleeding. Patient was subsequently referred for surgical intervention.

Final Diagnosis:

1. Acute gastric ulcer

2. Chronic pancreatitis

3. Liver cirrhosis due to alcoholism

4. Cirrhosis due to chronic hepatitis C

Procedure Performed: Subtotal gastrectomy with Billroth II anastomosis

Operative Procedure: The patient was brought to the operating room and placed on the table in a supine position, at which time general anesthesia was administered without difficulty. His abdomen was then prepped and draped in the usual sterile fashion. An upper midline incision was made. The peritoneum was then entered using the Metzenbaum scissors and hemostats. A retractor was placed, and he was noted to have a cirrhotic liver with micronodular cirrhosis. The left lobe of the liver was mobilized at that point, and the retractors were placed. On palpation of the stomach along the lesser curvature at approximately the mid portion, there was a large gastric ulcer located in the body of the stomach. At this point, the gastrocolic omentum was taken off the greater curvature of the stomach to the level just above the pylorus. Additionally, the lesser omentum was taken down off the lesser curvature of the stomach to the level of the pylorus. The body of the stomach was then transected approximately 3 cm above the ulcer. At that point, the stomach was reconstructed in a Billroth II fashion by bringing the jejunum through the transverse colon mesentery. Two stay sutures were placed to align the jejunum along the posterior wall of the stomach, and a GIA stapler was used to create the anastomosis without difficulty. The stomach and jejunum were then pulled below the transverse colon mesentery, and this was tacked in several places using 3-0 silk sutures. A feeding jejunostomy tube was then placed distal to this using the feeding jejunostomy kit without difficulty. The abdomen was then irrigated thoroughly using normal saline solution. Hemostasis was achieved using Bovie electrocautery. The midline incision was then closed using #1 PDS in a running fashion. The skin was closed using skin staples. A sterile dressing was applied. The patent was extubated in the operating room and returned to the Intensive Care Unit in guarded condition.

Provide ICD-10 CM

Hi everyone! I had my J-pouch made back at the start of November (surgery #2 of 3), and it's been a bit of a rollercoaster recovery since. About a week after discharge, I had a post-surgical infection that was caused by an abscess, which sent me back into hospital for antibiotics and I had a trans-gluteal drain placed for a bit over a week. The drain was some of the worst pain I've experienced, which is saying something after years of severe UC!

Anyways, that lead to yesterday, where I had a barium enema study performed where they found that my J-pouch has a tiny leak at the ileoanal anastomosis site, which was what had caused the abscess (which imaging shows I still have). Has anyone in this group experienced something similar? How long did it take to resolve, and did you need an additional surgery?

The radiologist said that because it's so small, I'd likely need to "just wait a little bit of time for it to heal", but he didn't have a timeline for that. I'm scheduled to follow up with my surgeon early in January, and I know that the barium enema study needs to show a healed J-pouch before they do the final surgery, meaning I'll need to do another one again soon.

As an aside/rant, this whole process has definitely hit my mental state hard, and I just feel so unlucky with how things are turning out. Not only was having UC unexpected, with no family history, I've passed through so many instances of "bad luck" so far - my UC was pancolitis; the three different rescue therapies they tried before surgery all failed; first surgery I had an ileus, now it's a J-pouch leak following an abscess with infection. All these instances where it's a 75-90 percent good outcome and I've fallen on the wrong side of that has me feeling pessimistic about the whole thing. I'm just eager to be done with this all and on the other side healing and getting back to a "normal" life. Phewww... Rant over.

Well, happy holidays to you all, and thank you for your support and community since I've started this journey!

He said he reattached an arm on the field in the middle of a warzone while he was in the army. He said the arm was "hanging by a thread." I said he must have had an immense supply of surgical tools and supplies, and he said "not really... the bone was still attached." Then I asked if he had to do an extensive vascular re-anastomosis on the spot. He said "not really." So I said it sounds like you just fixed an arm wound and he said "yeah..."

I did not think they actually acted like this in real life until I saw it in person!!

Two years I had a total abdominal colectomy (removal of my entire large bowel) with ileorectal anastomosis (my small intestine surgically connected to my rectum which was left in tact - which means I don't require a stoma).

The follow up care/education around ongoing gut health measures has been non existent and I have always wondered a few things:

With the large bowel being home to the majority of the beneficial bacteria, what happens when it's gone? Should I expect a weaker immune system?

Have I lost those species forever or can they re-establish in my small intestine over time?

What long term effects does the removal of that ecosystem have on a human body?

Will my body ever be capable of achieving homeostasis again?

Would a patient such as myself, with zero remaining large bowel, benefit or even be a suitable candidate for FMT?

Hi everyone, really happy I just stumbled upon this group on Reddit. Feels really great to be able to talk to other people who have gone through similar health issues. I wanted to see if anyone has had similar experiences as I have.

I’m 31 now, had my first diverticulitis attack in May of 2018. Thought it was just bad gas pain that wouldn’t go away. Went to my primary care doctor and he suspected it was diverticulitis (lower left abdominal pain), and he also told me I was way too young to be having it (not very comforting lol). The pain really bad over the next two days but quickly began to improve. I had been prescribed Flagyl/metronidazole and Cipro. After a few days I felt pretty much back to normal.

Fast forward to May of 2019. Had strep or some kind of throat infection. My doctor prescribed broad spectrum antibiotics, I think it was amoxicillin. After a few days I started getting the similar diverticulitis pains although these weren’t as painful as the first time. Went to the hospital and they confirmed through imaging I had a moderate case of diverticulitis. They also took a stool sample and found that I had a C. Diff (Clostridium Difficile) infection in my intestines. I think the amoxicillin is what caused the infection. They had me admitted to the hospital where I stayed for 4 nights basically quarantined in my room. I had no idea this was a really contagious infection, all of the staff were dressed in crazy masks and gowns when seeing me. This was before covid so it freaked me out at first. They had me on flagyl/metronidazole, Cipro, and Vancomycin. After leaving the hospital (around May 30, 2019), I felt pretty good for about a week. Then all of a sudden around June 10, 2019, after I ate anything, big or small, it felt like my entire abdomen was filling up like a balloon. For a good Month all I ate was 1 small bowl of oatmeal per day and maybe a yogurt. Anything more and I felt like I was going to explode. I did a lot of research on vancomycin and I think that’s what really messed me up.

Ever since June of 2019, all of my bowel movements have been mostly very thin, small little chunks, or diarrhea, and much more frequent (like 3-6 times per day.

A few months after this I had met regularly with my GI doctor. I wanted to get another colonoscopy to confirm what had happened to my insides (I previously had one a few months after my first attack of August 2018, confirmed diverticulosis) and he had said that he didn’t think I needed another one an

I don't want to step on anybody's toes here, but the amount of non-dad jokes here in this subreddit really annoys me. First of all, dad jokes CAN be NSFW, it clearly says so in the sub rules. Secondly, it doesn't automatically make it a dad joke if it's from a conversation between you and your child. Most importantly, the jokes that your CHILDREN tell YOU are not dad jokes. The point of a dad joke is that it's so cheesy only a dad who's trying to be funny would make such a joke. That's it. They are stupid plays on words, lame puns and so on. There has to be a clever pun or wordplay for it to be considered a dad joke.

Again, to all the fellow dads, I apologise if I'm sounding too harsh. But I just needed to get it off my chest.

It’s been a year since my wonderful surgeon ripped me a new a**hole. I figured I’d post since my tale is a little different. Perhaps someone will find something of value in here.

I had my first surgery back in 2011 after a seres of colonoscopies showed a ton of polyps, a few of which were both tiny and troubling. After a lot of soul searching and medical advice, I decided to go with what the docs recommended: a colectomy. I was 41 then, and I had an ileo-sigmoid anastomosis. In other words, they connected my ileum to my sigmoid colon (which had been polyp free). While I was assured my bowel function would be fairly normal, it was anything but. I had a decade of diarrhea and discomfort. I whittled my diet down to the few things I could eat without trouble, which left me with, essentially, carbs and protein.

In 2019, I started having a bunch of weird symptoms. Headaches, moments of vertigo, fatigue. I saw some doctors but didn’t take it too seriously until I started to have shortness of breath. Then came a few episodes of chest pain. A trip to the ER revealed that I was bleeding from my old surgical site. The anastomosis was failing.

I went to see a new surgeon, and he told me that an ileostomy was my only choice since anything else was likely to fail again.

It was a hell of a recovery: 3 NG tubes, 19 days in the hospital, an infected perianal incision (went for the action figure ass option), an episode of nasty stomach flu that landed me in the hospital again, a hernia, and months of leaks that tested my patience and my epidermis.

But now I’m cooking along. I get 4-5 days out of a pouch. My hernia gives me no trouble, my diet is awesome, and life is so much better.

Here’s what I’ve learned:

1. the people who love you want to help. Even though it is exhausting, it is a gift to be able to see someone through a difficult time.
2. it’s ok to be vulnerable and feel weak. In fact, it’s an essential part of healing.
3. your bag does not define you, nor does it shine like Rudolph’s nose. It’s just one of many characteristics that make you who you are.
4. you are amazingly strong and resilient
5. hernia belts are a lifesaver, especially when it comes to extending wear time.
6. the pouch manufacturers really want to help you find the right system, even if it is not theirs.
7. All suffering is relative, and all suffering is valid. You may have had more or less pain than others. That doesn’t minimize what you went through. So, don’t minimize it for yourse

Hi there. I'm a surgical oncologist starting in a very large hospital system that has not had an HPB surgeon or surgical oncology in many, many years. There are approximately ~10 people left in the system on the nursing side who have experience taking care of my post-operative patients (whipples, liver surgery, HIPEC, etc.).

I want to make the transition as easy as possible and contribute to education on for both the ICU and floor nursing. One of the ways I've seen this done very well at my fellowship (for thoracic surgery) was that the surgeons and APPs would both give lunch lectures occasionally to address turnover but also had a binder for each phase of care - one for the OR, one for the PACU/ICU, one for the floor nurses that outlined what they do, common conditions they treat, common management of their tubes and drains, post-operative course and timeline, discharge criteria, etc.

My questions and things I'm looking for feedback on what level of detail would you find useful for something like this? Would you even find this useful at all, or would you chuck it into a corner and never look at it? Would a seasoned nurse find this helpful vs. a newer nurse?

One of the things that made it work extremely well for thoracic surgery was that while they may treat a lot of diseases, you could really boil it down to like two to three major disease processes (lung cancer, bad pneumonia, esophageal cancer) and the operations were some version of lung resection (wedge, lobe, bilobe, pneumonectomy) or esophagectomy with very little practical difference between any more nuance than that. Chest tube management, floor orders, what to watch for was essentially identical in every patient population/disease they operated on. For me, liver surgery is much different from pancreas is much different from gastrectomy, multi-visceral sarcoma, kidney resections, esophageal surgery, and CRS/HIPEC is its own beast totally separate. There are a lot of common denominators for post-op orders and lines but the complications and things to watch out for are very different.

Anyway, that said, I was thinking of something like this:

• Short outline of surgical oncology and hepatobiliary surgery
• Cancers and benign conditions we treat/operate on
• Overview of the common big operations
• Generic postoperative orders, lines/tubes
• Specific complications and warning signs for each type of surgery
• ERAS pathways/goals
• Discharge criteria, common D/C meds/issues/barriers

With this fram

The nurse asked the rabbit, “what is your blood type?”

“I am probably a type O” said the rabbit.

The doctor says it terminal.

Mentos

(I will see myself out)

Alot of great jokes get posted here! However just because you have a joke, doesn't mean it's a dad joke.

THIS IS NOT ABOUT NSFW, THIS IS ABOUT LONG JOKES, BLONDE JOKES, SEXUAL JOKES, KNOCK KNOCK JOKES, POLITICAL JOKES, ETC BEING POSTED IN A DAD JOKE SUB

Try telling these sexual jokes that get posted here, to your kid and see how your spouse likes it.. if that goes well, Try telling one of your friends kid about your sex life being like Coca cola, first it was normal, than light and now zero , and see if the parents are OK with you telling their kid the "dad joke"

I'm not even referencing the NSFW, I'm saying Dad jokes are corny, and sometimes painful, not sexual

So check out r/jokes for all types of jokes

r/unclejokes for dirty jokes

r/3amjokes for real weird and alot of OC

r/cleandadjokes If your really sick of seeing not dad jokes in r/dadjokes

Punchline !

Edit: this is not a post about NSFW , This is about jokes, knock knock jokes, blonde jokes, political jokes etc being posted in a dad joke sub

Edit 2: don't touch the thermostat

Do your worst!

How the hell am I suppose to know when it’s raining in Sweden?

Mathematical puns makes me number

We told her she can lean on us for support. Although, we are going to have to change her driver's license, her height is going down by a foot. I don't want to go too far out on a limb here but it better not be a hack job.

Ants don’t even have the concept fathers, let alone a good dad joke. Keep r/ants out of my r/dadjokes.

But no, seriously. I understand rule 7 is great to have intelligent discussion, but sometimes it feels like 1 in 10 posts here is someone getting upset about the jokes on this sub. Let the mods deal with it, they regulate the sub.

They were cooked in Greece.

I'm surprised it hasn't decade.

He lost May

Now that I listen to albums, I hardly ever leave the house.

Said if she ever hosts a gender reveal party, when it comes time to pop the balloon she'll spray everyone with water.

Gender is fluid.

Hi all, I am curious about those who have used Endoscopic Therapy to treat small bowel strictures / narrowing? Has it been successful or have you had to resort to surgery / resection? I have also read there is a high correlation between opiate use/abuse/overuse and this issue as well as narcotic bowel syndrome.

I was reading the Clinical review article: Endoscopic Therapy in Crohn’s Disease: Principle, Preparation, and Technique:

"Although surgical intervention, including bowel resection with anastomosis and stricturoplasty, is effective in the management of strictures, it is often associated with a high risk of postoperative complications and disease recurrence

We may use the following phrase to describe the natural history of disease in the majority of patients with CD “no inflammation, no stricture; no stricture, then no fistula; and no fistula, no abscess.” This notion and clinical observation have led to a rationale of treating the disease aggressively at the time of diagnosis, with the intention to modify the disease course. Once “mechanical” complications (e.g., strictures and/or fistulae) develop, the role of medical therapy is limited. Those mechanical complications usually require the treatment in a “mechanical way,” with endoscopic and/or surgical therapies.

Source: Endoscopic Therapy in Crohn’s Disease: Principle, Preparation, and Technique
Copyright © 2015 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000433 Published online 19 May 2015.

Two muffins are in an oven, one muffin looks at the other and says "is it just me, or is it hot in here?"

Then the other muffin says "AHH, TALKING MUFFIN!!!"

Don't you know a good pun is its own reword?

But let me give it a shot.

For context I'm a Refuse Driver (Garbage man) & today I was on food waste. After I'd tipped I was checking the wagon for any defects when I spotted a lone pea balanced on the lifts.

I said "hey look, an escaPEA"

No one near me but it didn't half make me laugh for a good hour or so!

Edit: I can't believe how much this has blown up. Thank you everyone I've had a blast reading through the replies 😂

It really does, I swear!

He’s the new temp.

And now I’m cannelloni

Because she wanted to see the task manager.

But that’s comparing apples to oranges

And boy are my arms legs.

Amy

Put it on my bill

Heard they've been doing some shady business.

but then I remembered it was ground this morning.

Edit: Thank you guys for the awards, they're much nicer than the cardboard sleeve I've been using and reassures me that my jokes aren't stale

Edit 2: I have already been made aware that Men In Black 3 has told a version of this joke before. If the joke is not new to you, please enjoy any of the single origin puns in the comments

BamBOO!

They’re on standbi