Liberty

𝗔𝗻𝘁𝗲𝗿𝗶𝗼𝗿 𝗚𝗮𝘀𝘁𝗿𝗼𝘀𝘁𝗼𝗺𝘆 𝗮𝗻𝗱 𝗥𝗲𝘁𝗿𝗶𝗲𝘃𝗮𝗹 𝗼𝗳 𝗜𝗺𝗽𝗮𝗰𝘁𝗲𝗱 𝗛𝗼𝘁 𝗔𝘅𝗶𝗼𝘀 𝗦𝘁𝗲𝗻𝘁 🔴Anterior gastrostomy just at level of palpable bulge and proximal to pylorus ➡️Correlated with Hot Axios position on CT 🔴3/0 PDS used as stay sutures to improve visibility ➡️Just anterior leaf of gastrostomy ➡️To falciform using slip knot 🔴Despite manoeuvres described difficult to visualise Hot Axios stent 🔴Ligaclips applied to mucosa where stent could be palpated 🔴Intraoperative XR screening used to orientate the stent in relation to ligaclips 🔴Hook diathermy used to divide stomach mucosa to the right of the ligaclips to identify the stent which proved to be unsuccesful 🔴Real time IOUS utilised ➡️Critical step ➡️Key in identifying location of Hot Axios stent 🔴Once identified the stent which buried beneath the mucosa was removed with careful traction 🔴Bleeding encountered upon stent retrieval ➡️Controlled with pressure, judicious use of diathermy and placement of Veriset 🔴Anterior gastrostomy sutured close in 2 layers with 3/0 PDS 🔴Postoperatively patient started on IV PPI and initiated on oral fluids and diet in stepwise manner #FOAMed #GITwitter #EUS #HPB #SoMe4Surgery #surgery