# Revision of Nissen fundoplication through thoracotomy



## ktsirtsan (Oct 26, 2010)

If anybody knows how to code this, please let me know:

A standard left posterior wall thoracotomy was performed... we took down the previous Nissen fundoplication, which appeared to have slipped up above the GE junction. The Nissen fundoplication was then divided using the Echelon-45 stapling device with the gold load. At this point, I carefully identified the GE junction. With the distal esophagus mobilized from the level of the inferior pulmonary vein down to the diaphragm there appeared to be more than adequate length of the esophagus. Multiple interrupted Quill sutures were now placed at this time to reapproximate the left and right crus of the diaphragm. These were tagged, but not tied at this time. Working together with Dr. X, we then created a 4-stitch 270-degree Belsey fundoplication.

As you can see, this fundoplication was done through the thoracotomy, not the abdominal incision described in the 43324. The only thing I can think of using unlisted code...


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