codedog
True Blue
anyone know what this would come out to be coded as ? i see he did an anastomosis , but also ileostomy , thanks
Procedure: Ileocolic resection with end ileostomy
Pre-Operative Diagnosis: Pneumoperitoneum [K66.8]
Specimens: Ileocolic anastomosis
Description of Technical Procedures: After informed consent was obtained, patient was brought to the operating room and placed in the supine position. Next general endotracheal anesthesia was administered by member of the anesthesia team. The abdomen was prepped and draped in sterile surgical fashion. The upper midline incision was extended with a 10 blade and electrocautery. The PDS suture was cut in the laparotomy was reopened. A medium Alexis wound protector was utilized. Exploration of the right upper quadrant was performed and old hematoma and feculent material encountered. The anastomosis was then delivered into the wound. There was a 5-10 mm hole along the colon transection staple line and a pinhole near the apex of the anastomosis. The colon was transected just distal to the anastomosis using a TLC 75 mm stapler with a blue cartridge. The ileum was divided similarly. Mesentery was divided with the LigaSure impact. The right upper quadrant and pelvis was irrigated with copious amounts of warm saline. His mesentery was very friable and bled easily. A circular skin incision was then made in the right lower quadrant with a 15 blade. It was deepened with electrocautery. A vertical incision was made in the anterior rectus sheath and muscle-splitting technique was employed. The posterior fascia and peritoneum was incised to permit 2 fingers. The ileum was then easily delivered through this wound. A 19 French Blake drain was placed in the right abdomen and brought out through a separate stab incision in the right lateral abdominal wall. It was secured to the skin with a 2-0 silk suture. Seprafilm was laid throughout the abdominal cavity. The midline fascial defect was repaired with running loop PDS suture. Subcutaneous tissue was irrigated and the skin edges reapproximated with skin staples. Incision was isolated with a blue towel. Staple line was excised off of the ileum and an end ileostomy was matured in a Brooke fashion using interrupted 3-0 Vicryl sutures. The incision was cleaned and a sterile dressing was applied. An ostomy appliance placed around the ileostomy. Drain was cut to the appropriate length and attached to bulb suctioned. Patient tolerated the procedure well and there were no complications. He was awakened and extubated in the operating room then subsequently transferred to recovery in satisfactory condition.
Procedure: Ileocolic resection with end ileostomy
Pre-Operative Diagnosis: Pneumoperitoneum [K66.8]
Specimens: Ileocolic anastomosis
Description of Technical Procedures: After informed consent was obtained, patient was brought to the operating room and placed in the supine position. Next general endotracheal anesthesia was administered by member of the anesthesia team. The abdomen was prepped and draped in sterile surgical fashion. The upper midline incision was extended with a 10 blade and electrocautery. The PDS suture was cut in the laparotomy was reopened. A medium Alexis wound protector was utilized. Exploration of the right upper quadrant was performed and old hematoma and feculent material encountered. The anastomosis was then delivered into the wound. There was a 5-10 mm hole along the colon transection staple line and a pinhole near the apex of the anastomosis. The colon was transected just distal to the anastomosis using a TLC 75 mm stapler with a blue cartridge. The ileum was divided similarly. Mesentery was divided with the LigaSure impact. The right upper quadrant and pelvis was irrigated with copious amounts of warm saline. His mesentery was very friable and bled easily. A circular skin incision was then made in the right lower quadrant with a 15 blade. It was deepened with electrocautery. A vertical incision was made in the anterior rectus sheath and muscle-splitting technique was employed. The posterior fascia and peritoneum was incised to permit 2 fingers. The ileum was then easily delivered through this wound. A 19 French Blake drain was placed in the right abdomen and brought out through a separate stab incision in the right lateral abdominal wall. It was secured to the skin with a 2-0 silk suture. Seprafilm was laid throughout the abdominal cavity. The midline fascial defect was repaired with running loop PDS suture. Subcutaneous tissue was irrigated and the skin edges reapproximated with skin staples. Incision was isolated with a blue towel. Staple line was excised off of the ileum and an end ileostomy was matured in a Brooke fashion using interrupted 3-0 Vicryl sutures. The incision was cleaned and a sterile dressing was applied. An ostomy appliance placed around the ileostomy. Drain was cut to the appropriate length and attached to bulb suctioned. Patient tolerated the procedure well and there were no complications. He was awakened and extubated in the operating room then subsequently transferred to recovery in satisfactory condition.