# Help coding Repair of hepaticojejunostomy



## rosalyn reis (Jun 29, 2010)

Not sure what codes to use for this op note.  Any help would be appreciated.
Here is op report.
Pt had pancreaticoduodenectomy two days ago and now has developed fever.

Findings: There was a small amount of bilious ascites present in the RUQ. There was minimal peritonitis present.  The hepaticojejunostomy was notable for disruption of several of the anastomotic sutures on the anterior aspect.  It appeared that these sutures had torn through the hepatic duct. The gastrojejunostomy and the pancreaticojejunostomy were intact.

Procedure: The pts preexisting laparotomy incision was reopened. The bilious ascites was evacuated. The area was explored and the disruption in the hepaticojejunostomy was immediately apparent. The preexisting internal stent in the hepaticojejunostomy was removed. A 8-french pediatric feeding tube was selected and fashioned into a new stent by removing the closed end and cutting multiple extra side holes. The stent was passed into the afferent jejunal limb through a small stab incision about 15 cm distal to the hepaticojejunostomy. The stent was placed through the hepaticojejunostomy and approximately 2 cm into common hepatic duct. The stent was escured and attached to the jejunum at the exit site with a 4-0 PDS pursestring suture. The insertion site was then inverted in a Witzel fashion with interrupted 4-0 PDS Lembert sutures. The disrupted anterior aspect of the hepaticojejunostomy was then repaired as best as possible by placing two 5-0 PDS interrupted sutures. The area was irrigated and suctioned. Hemostasis was complete.

Any thoughts would be great.


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