# laparoscopic transgastric remnant EGD



## lindacoder (Jul 31, 2013)

Help please, patient had prior gastric bypass

PROCEDUREL diagnostic laparoscopy, laparoscopic incisional hernia repair, LOA, transgastric remnant EGD

Stab incision was made to the left of the umbilicus and bladeless trocar was inserted intraperitoneally,  Pneumoperitoneum was created with CO2 insufflation to 15 mmHg pressure with good 4 quadrant typmany. Under direct vision with the laparoscope a right upper abdominal 5 mm and left upper quadrqant 5 mm stab incisions were made and trocars were insterted into the abdomen. There was an obvious hernia at the site of the larger prior left lateral trocar site. Using sharp dissection, I took down adhesions in this area and reduced the hernia. I then placed a 10 mm trocar site through this prior trocar site and through the hernia. Additional adhesions were taken down with sharp dissection. The entire abdominal contents were then explored. The gastrojejunostomy anastomosis was unremarkable. The visualized pouch was unremarkable. The visualized remnant stomach was unremarkable. The duodenum appeared unremarkable, a Kocher maneuver was performed. The Roux limb was run from the gastrojejunostomy to the enteroenterostomy and was unremarkable. The biliopancreatic limb was unremarkable. The common channel down to the ileocecal valve was unremarkable. We did not see any pathology in the visualized colon. Because of the history of duodenitis it was elected to proceed with a transgastric remnant endoscopy. The gastric remnant was brought up in opposed next to the 10 mm left lower quadrant trocar site. Using a long trocar, we entered the gastric remnant with a blunt trocar. We then passed the endoscope through the trocar and visualized the remnant stomach, duodenum and then jejunum all the way down to the enteroenterostomy. This was completely unremarkable. There was no evidence fo ulcer, mass or other pathology. Air was desufflated and the scope was withdrawn. The gastrotomy created by this trocar ws closed with the firing of an Echelon stapler. The endoscope was completely removed and then we performed a routine upper endoscopy transorally. The esophagu was unremarkable. There was no evidence of esophagitis or mass. The scope was advanced into the gastric pouch which was appropriately sized without evidence of gastritis,gastric ulcer or mass. The scope easily passed the gastrojejumostomy which was unremarkable, there was no evidence of maginal ulcer. We advanced the scope down the Roux limb, which was unremarkable. Air was desufllated and the scope was withdrawn. With this complete we then repaired the incisional hernia. This was done with transfascial sutures of 0 Vicryl with good closure of the hernia. Hemostasisi was assured thoughout. With hemostasis assured, the pneumoperitoneum was allowed to desufflate and the trocars removed.The skin of all incisions was closed with subcuticular 4-0 Monocryl. 

Looking at 49654 for hernia,
43289 for transgastric remnant EGD   ????? if so any comparison to come up with a price
43235 for regular EGD

Thank you


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