lindacoder
Guest
Not sure how to code the following - this was all done laparoscopically.
Once this was completed, we then directed our attention over to the gallbladder to palpate as it did appear to be moderately distended, and on palpation, it was noted that there were palpable stones. Prior to closure and completion of the pyloroplasty, we did identify the gastric duodenal artery. This was carefully dissected out from the surrounding tissue and suture ligated with 2-0 Vicryl stitch. During this process, we did note that the common bile duct appeared to be extremely dilated and therefore after closure of the stomach and the duodenum, we directed our attention over to the gallbladder where again stones were palpated. We proceeded to perform a cholecystectomy dissecting the gallbladder in a retrograde fashion down to the structures of the triangle of Calot where the cystic artery was isolated, clipped and divided. The cystic duct was also isolated, clipped and divided as well. At this point, we were able to palpate further the common bile duct and noted that there were several stones within the common bile duct. Therefore, a choledochotomy was performed in a longitudinal fashion along the common bile duct using a #15 blade, and there was immediate extrusion of some large gallstones. At this point, proceeded to then perform a common bile duct exploration using a size 5 Fogerty proceeding proximally and distally to pull up any further stones. There were several more stones that were pulled out in this fashion. Once this was completed, an 18 French T tube was then fashioned and proceeded to place this within the common bile duct and this was secured in place, closing the choledochotomy in a running fashion using a 5-0 PDS stitch. A cholangiogram was then shot through the T2 and we were able to visualize both the intrahepatic and extrahepatic duct. The contrast flowed easily into the duodenum. There was no evidence of any stones noted at this point. Therefore, the T tube was then brought out through the abdominal wall.
Any guidance is appreciated!!
Once this was completed, we then directed our attention over to the gallbladder to palpate as it did appear to be moderately distended, and on palpation, it was noted that there were palpable stones. Prior to closure and completion of the pyloroplasty, we did identify the gastric duodenal artery. This was carefully dissected out from the surrounding tissue and suture ligated with 2-0 Vicryl stitch. During this process, we did note that the common bile duct appeared to be extremely dilated and therefore after closure of the stomach and the duodenum, we directed our attention over to the gallbladder where again stones were palpated. We proceeded to perform a cholecystectomy dissecting the gallbladder in a retrograde fashion down to the structures of the triangle of Calot where the cystic artery was isolated, clipped and divided. The cystic duct was also isolated, clipped and divided as well. At this point, we were able to palpate further the common bile duct and noted that there were several stones within the common bile duct. Therefore, a choledochotomy was performed in a longitudinal fashion along the common bile duct using a #15 blade, and there was immediate extrusion of some large gallstones. At this point, proceeded to then perform a common bile duct exploration using a size 5 Fogerty proceeding proximally and distally to pull up any further stones. There were several more stones that were pulled out in this fashion. Once this was completed, an 18 French T tube was then fashioned and proceeded to place this within the common bile duct and this was secured in place, closing the choledochotomy in a running fashion using a 5-0 PDS stitch. A cholangiogram was then shot through the T2 and we were able to visualize both the intrahepatic and extrahepatic duct. The contrast flowed easily into the duodenum. There was no evidence of any stones noted at this point. Therefore, the T tube was then brought out through the abdominal wall.
Any guidance is appreciated!!