# I need help with this laparotomy with sigmoid colectomy



## driley6@hvc.rr.com (Mar 17, 2016)

Can someone help me with this, I can't seem to figure out what codes I need to use for this procedure. The patient has sigmoid colon cancer he is the op report. Thanks for your help!!

Obstructing sigmoid colon lesion
Description: The patient was brought to the operating room and placed in the supine position.  The identification, medical chart, and consents were verified for accuracy.  After a smooth induction of general anesthesia, the appropriate antibiotics were infused and a Foley catheter placed without complication.  The patient was re-positioned into a low lithotomy position and all pressure points checked and padded.  A distal betadine washout was performed and the abdomen was prepped and draped using sterile technique.  A “time out” was performed where the patient’s operative site, planned procedure, allergies, and required equipment were identified.   Once all participating staff was in agreement, the procedure commenced.  A midline incision was made from the umbilicus to the pubis.  Subcutaneous fat was dissected to the anterior abdominal wall fascia which was divided at the midline.  After the peritoneum was safely incised, a thorough exploration of the abdomen was performed and demonstrated the known sigmoid colon lesion and multiple cystic lesions in both liver lobes.  The NGT was palpated in the stomach and taped into position by the Anesthesiologist.  The small intestine was gently retracted to the right side of the abdomen and covered with warm moist sponges.  The left colon was freed from its peritoneal attachments along the avascular line of Toldt from the rectal peritoneal reflection beyond the splenic flexure.  The left ureter was identified and preserved as the left colon was mobilized medially.  Points of transaction were selected proximally in a manner where healthy appearing bowel and palpable mesenteric pulses allowed.  A hard constricting lesion was identified in the sigmoid colon which corresponded with her preoperative endoscopic findings.  We ensured that at least 5cm of healthy uninvolved colon was present both proximally and distally from this lesion.  We also ensured that the involved mesentery to the aorta was included with the specimen.  The bowel was divided using a linear cutting stapling device.  The mesenteric peritoneum was scored until the sigmoid artery and vein were identified and ligated using 2- 0 silk ligatures.   The distal simoid colon was dissected to the peritoneal reflection and where the tenia splayed marking the proximal rectum.  An intestinal stapling device was used to divide the distal sigmoid colon at the level of the sacral promontory.  The specimen was marked with a suture and labeled for pathologic analysis.  Hemostasis was checked on the operative field and the two bowel ends confirmed to be healthy and viable.  The proximal and distal segments were brought into apposition and found to lie comfortably in opposition to one other.  The EEA stapler button device was sized to fit the colonic lumen (29mm), then a 3-0 Proline suture used to purse string the button to the proximal colonic segment.  The EEA stapling device was inserted through the rectum and attached to the button.  The cutting stapler device was deployed and retracted.  The button was recovered and the two intestinal rings inspected for integrity.  Once satisfied, the anastamosis was rechecked for patency using an air-water technique with a rigid proctoscope.  A suspected weak point at the anastomosis was reinforced with a two layer closure using 3-0 Vicryl running suture and 3-0 silk Lembert sutures.  The air-water test was repeated with no leak.  Next the mesenteric defect was obliterated using 3-0 Silk in a running pattern.  The abdominal cavity was copiously irrigated and the viscera returned to their natural anatomic position.  Excess fluid was suctioned from the operative field as hemostasis was verified.    A representative cystic lesion/ wedge biopsy of the left liver lobe was taken and sent to the Pathology service.  After hemostasis was obtained using electrocautery, the omentum and Sepra Film were placed over the anterior visceral surface and the fascia closed using 1 PDS in a running pattern. Skin was closed using 3-0 Monocryl in a running subcuticular pattern.  Steri-strips and sterile dressings were applied, and the patient was extubated in the operating suite.  The patient was transferred to the post-operative care unit in stable condition and arrived alert and interactive.  There were no known complications and the patient appeared to tolerate the procedure well.  As the attending surgeon I was scrubbed and present for the entire procedure.


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## syllingk (Mar 17, 2016)

looks pretty straight up to me. I came up with 44140, 44139, 47100-51.


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## CELADYBUG13 (Mar 18, 2016)

Agree.


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## driley6@hvc.rr.com (Mar 18, 2016)

Thank you so much!


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