# HELP! Surgical repair of hepatic duct with heaticojejunostomy Roux-en-Y anastomosis



## Snflwr81 (Apr 18, 2013)

Op Report:
1. Laparoscopic cholecystecomy with operatice cholangiogram
2. Choledochoscopy
3. Surgical repair of transected common hepatic duct with a hepaticojejunostomy Roux-en-Y anastomosis
4. Placement of a 10-French feeding tube as a drain in the biliary duct as a stent

***I'm not including the lap chole dictation***
....there was noted to be a tubular structure appearing at the end. It was noted that this was an injury to the common bile duct. Upon inspection, the abdomen was opened. We were careful to make sure that the right and left hepatic ducts were within the specimen and there was no injury to those upper ducts, just the common hepatic duct. The artery was identified and suture ligated. Once that was complete, a choledochoscope was used to look up the radicals in order to assure that there was enough length to do an anastomosis. Both radicals appeared good, with a good amount of length present.

The ligament of the Treitz was identified. The stomach was identififed and the deodenum was identified. About 20cm past the ligament of Treitz, the small bowel was seperated. The free loop of the small bowel that had been seperated was brought up as the jejuostomy loop to the liver area and hepatic injury. The mesentary was divided. Good viable small bowel was obtained. A small hole was made retrocolic for the small bowel repair. Once this was brought up, it was sutured to the common hepatic duct using 3-0 Monocryl to suture this. Two inferior stitches were done on the bowel after a small enterotomy was made in the small bowel; two lateral, two medial and then two superior stitches were placed. Once that was completed, the small bowel feeding tube was obtained, a 10-French feeding tube. This was placed in the common hepatic duct as a stent. The small bowel was brought up to the repair site and then tied into position. It was then tacked up against teh liver as well to assure that it would not pull away. Once that was completed, the small bowel was then tacked up with silk sutures to the abdominal wall to form a seal around this. Once complete, two Blake drains were placed around the repair.

The Y portion of the Roux-en-Y limb was stapled to the small bowel and the antimesentric areas. Linear 55-cm stapler was used and then a TA-60 was brought across the base of this and imbricated to assure that there was no leak. Once that was completed and the drains were in position, the abdomen was irrigated. The extended subsostal incision was closed then with looped PDS and the skin was stapled. The drains were sutured into position. Care was taken not to dislodge the 10-French feeding tube at all. 

Can anyone help me code this???? What I have so far is 47563; 47550; and 47785, but I'm really not sure if 47785 is correct.


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## morales1968 (Apr 30, 2013)

The common hepatic duct is extra-hepatic so based on your note I would assign 47785.


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