Before Landing
Moshe Schein
Takeoffs are optional. Landings are mandatory.
Everyone knows that a “good landing” is one from which you can walk away.
But very few know the definition of a “great landing.”It’s one after which you can use the airplane another time.Yes, we know that you are tired; you may have worked all night and this may be the last of many long cases. But any landing must be perfect and even this last operation has to succeed.
Before closing the abdomen you must be absolutely happy with what you did.
Prevent “guilt-worry”. Always ask yourself “Am I totally satisfied with my proce- dure?” (> Fig. 39.1). Don’t silence the little voice within you that informs you that the anastomosis is somewhat dusky.You must be absolutely convinced, at this stage, that you have done the best that your patient deserves. If not, swallow your pride, do it again, or call for help. Hiding a potential problem will not solve it.And you will go back to sleep so much better.
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Fig. 39.1. “Am I satisfied?”
You may want to go over a pre-closure checklist:
Hemostasis perfect?This does not mean that you have to run after each red blood corpuscle…
Source controlachieved?
Peritoneal “toilet”completed? All fluid sucked out?
Anastomosis: Viable? Not under tension, lying well?
Potential sites for internal herniation dealt with?
Small bowelcomfortably arranged in place below the transverse colon?
Omentumplaced between intestine and incision?
All additional fascial defects (e.g. trocar sites) closed?
Drains(only if indicated!) in place?
Need a feeding jejunostomy?
Should I closethe abdomen at all? Or leave it open?
Do not compromise. Keep looking around; there’s always something you’ve missed.Remember: when the abdomen is open you control it, when closed it controls you!
There are old pilots, and there are bold pilots, but there are no old, bold, pilots!
There are however old, bold surgeons – but their patients do not live long…
344 Moshe Schein
After the Operation IV
