tracey_meissel
New
Here is the OP note. I am thinking 47610 with 574.00 and v64.41 but I also think the silastic drain should be coded. I can't find anything that is close so I am asking for ideas. PREOPERATIVE DIAGNOSIS: Symptomatic cholelithiasis.
POSTOPERATIVE DIAGNOSIS: Symptomatic cholelithiasis.
PROCEDURE PERFORMED: Attempted laparoscopic cholecystectomy, convergent to open cholecystectomy.
ANESTHESIA: General.
ANESTHESIOLOGIST:
ESTIMATED BLOOD LOSS: 100 cc.
OPERATIVE NOTE: After administration of general endotracheal anesthesia, the patient's abdomen was then prepared and draped in the usual manner. A 2-cm transverse incision was made just superior to the umbilicus. A Veress needle was inserted in the peritoneal cavity and CO2 was instilled to create an adequate pneumoperitoneum. A 10-mm trocar was advanced through the umbilical wound and a 10-mm, 30-degree laparoscope was advanced through the umbilical port. Under direct laparoscopic vision, three 5-mm ports were placed in the right upper quadrant one in the epigastric midline, one in the right subcostal midclavicular line, one in the right lateral subcostal line. The gallbladder was viewed. There was no evidence of acute inflammation. The fundus was retracted superiorly and the infundibulum laterally. This cystic duct was bluntly dissected. The cystic duct was isolated and dissected distally. A hole was made in what appeared to be the cystic duct and common duct junction. Initially, I could not be certain whether this was a part of the cystic duct or in the common duct itself. Additional dissection revealed that this was likely in the common bowel duct. I elected to abort the laparoscopic approach. A right subcostal incision was made. The cystic artery was isolated and then clipped once proximally, twice distally, and transected. The gallbladder was removed from its bed using electrocautery. The common bile duct area was then explored. The open was identified. It definitely appeared to be in the common bile duct and it appeared to be at the site where the cystic duct had entered. The duct was moderate sized and I felt that it would be safe to close it with a lateral repair. Accordingly, 3-0 Vicryl suture was used to close the bile duct with small bites to make certain that the lumen was not compromised. One repair suture of 3-0 Vicryl was necessary. The cystic duct stump was identified and clipped twice. The abdominal cavity was irrigated with saline and aspirated dry. A 10-mm round silastic drain was placed in the subhepatic space and brought out inferior and medial to the incision where it was secured with 2-0 silk suture. The abdominal fascia was closed in two layers using running 1-Vicryl on the posterior fascia and peritoneum and a running #1 Prolene on the anterior fascia. All skin incisions were closed with running and interrupted 4-0 subcuticular Monocryl. Sterile dressings were applied. The patient tolerated the procedure well and left the operating room in satisfactory condition.
POSTOPERATIVE DIAGNOSIS: Symptomatic cholelithiasis.
PROCEDURE PERFORMED: Attempted laparoscopic cholecystectomy, convergent to open cholecystectomy.
ANESTHESIA: General.
ANESTHESIOLOGIST:
ESTIMATED BLOOD LOSS: 100 cc.
OPERATIVE NOTE: After administration of general endotracheal anesthesia, the patient's abdomen was then prepared and draped in the usual manner. A 2-cm transverse incision was made just superior to the umbilicus. A Veress needle was inserted in the peritoneal cavity and CO2 was instilled to create an adequate pneumoperitoneum. A 10-mm trocar was advanced through the umbilical wound and a 10-mm, 30-degree laparoscope was advanced through the umbilical port. Under direct laparoscopic vision, three 5-mm ports were placed in the right upper quadrant one in the epigastric midline, one in the right subcostal midclavicular line, one in the right lateral subcostal line. The gallbladder was viewed. There was no evidence of acute inflammation. The fundus was retracted superiorly and the infundibulum laterally. This cystic duct was bluntly dissected. The cystic duct was isolated and dissected distally. A hole was made in what appeared to be the cystic duct and common duct junction. Initially, I could not be certain whether this was a part of the cystic duct or in the common duct itself. Additional dissection revealed that this was likely in the common bowel duct. I elected to abort the laparoscopic approach. A right subcostal incision was made. The cystic artery was isolated and then clipped once proximally, twice distally, and transected. The gallbladder was removed from its bed using electrocautery. The common bile duct area was then explored. The open was identified. It definitely appeared to be in the common bile duct and it appeared to be at the site where the cystic duct had entered. The duct was moderate sized and I felt that it would be safe to close it with a lateral repair. Accordingly, 3-0 Vicryl suture was used to close the bile duct with small bites to make certain that the lumen was not compromised. One repair suture of 3-0 Vicryl was necessary. The cystic duct stump was identified and clipped twice. The abdominal cavity was irrigated with saline and aspirated dry. A 10-mm round silastic drain was placed in the subhepatic space and brought out inferior and medial to the incision where it was secured with 2-0 silk suture. The abdominal fascia was closed in two layers using running 1-Vicryl on the posterior fascia and peritoneum and a running #1 Prolene on the anterior fascia. All skin incisions were closed with running and interrupted 4-0 subcuticular Monocryl. Sterile dressings were applied. The patient tolerated the procedure well and left the operating room in satisfactory condition.