# Laparoscopic assisted lower anterior colon resection, takedown of colovaginal fistula



## alex1990 (Jan 27, 2015)

Pre-op Diagnosis: Colovaginal fistula [619.1]

Post-op Diagnosis: Colovaginal fistula

Procedure(s):

LAPAROSCOPIC ASSISTED LOWER ANTERIOR COLON RESECTION, TAKEDOWN OF COLOVAGINAL FISTULA

Laterality: N/A

Approach: Laparoscopic and Open
Implant(s):  * No implants in log *

Clinical Indications:  Patient colovaginal fistula


Description of procedure:  Patient brought to the operative theater, induced under general anesthesia, placed in low lithotomy position with Yellofins, and after Foley catheter and orogastric decompression were obtained. The patient was prepped and draped in the usual sterile fashion. At this point, a left subcostal incision was made under direct visualization using an Optiview port. The abdomen was penetrated and insufflated to 15 mmHg. Then right lower quadrant, right upper quadrant ports were placed and the patient was placed in steep Trendelenburg position, rotated to the right. The area of recurrent diverticulitis was immediately identified in the left lower quadrant which appeared to be adherent to the pelvic sidewall and left lower abdominal area. At this point, the left colon was mobilized medially along the white line of Toldt up to the splenic flexure. The splenic flexure itself was dissected and mobilized. Dissection was then continued downward until we again reached the area of disease and carefully dissected it off the abdominal wall, using sharp and blunt dissection. Once we had this completely dissected, dissection was continued until we identified the ureter keeping it out of harm's way. A rent in the mesentery was then made and the mesentery was divided using the Harmonic scalpel. This was done as we mobilized into the rectum, the lateral peritoneal reflection. Then we entered the posterior rectal space and continued the dissection sharply and bluntly dissecting the colon from the vagina. until we had completely mobilized. At this point, a small midline incision was made approximately 3 cm in size, and the abdomen was entered. A wound protector was then placed and the bowel was then brought up. Proximal and distal resection margins were identified, chosen, and divided using a linear stapler and the distal margin was divided using a contour. At this point, using a double staple technique, the anastomosis was constructed to reconstitute continuity of bowel. The anastomosis was inspected visually and hydrostatically underwater using a sigmoidoscope, no bubbles were noted. All of the abdomen was then again irrigated until clear. The abdominal contents were then allowed to return to their anatomical position. The omentum was placed over the bowel. The incision was then closed using skin staples. Sterile dressings were applied. The patient was then brought to recovery room in stable condition. Instrument, sponge, and lap counts were all correct.

Findings:  Chronic diverticular disease with fistula between colon and vagina


Complications:  none

Can someone please help me, on how to go about coding this Opt. Report please, I'll apreciate any help.
Thanks,


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## cynthiabrown (Jan 30, 2015)

this would be a laparoscopic procedure low pelvic anastomosis with mobilzation of splenic flexure. 44207 +44213. Any time a fistula is closed by a colon resection, the closure of the fistula is inclusive


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## lindacoder (Jan 30, 2015)

I think it should be unlisted 44238 with comparible open code 44661


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## cynthiabrown (Jan 30, 2015)

enterovesical fistula is intestine/bladder.......................not intestine/vagina


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