couple of things in this op report if anyone could help.
Approach: Laparoscopic
Having trouble looking for gastrogastric fistula resection code/Internal hernia repair = 43659 (need a code to compare to $$)
PREOPERATIVE DIAGNOSES:
1. RECURRENT ABDOMINAL INCISIONAL HERNIA.
2. ABDOMINAL PAIN.
POSTOPERATIVE DIAGNOSES:
1. RECURRENT ABDOMINAL INCISIONAL HERNIA.
2. INTERNAL HERNIA.
3. HIATAL HERNIA.
4. GASTROGASTRIC FISTULA.
5. ADHESIONS.
OPERATION PERFORMED:
1. DIAGNOSTIC LAPAROSCOPY.
2. GASTROGASTRIC FISTULA RESECTION.
3. INTERNAL HERNIA REPAIR.
4. PRIMARY INCISIONAL HERNIA REPAIR
5. LYSIS OF ADHESIONS ABOUT 30 MINUTES IN DURATION.
SURGEON:
xxxxx
ANESTHESIA:
GENERAL ENDOTRACHEAL.
Complications: None. Estimated blood loss: 25 mL.
FINDINGS:
1. The patient had a hiatal hernia that was appreciated.
2. There was also evidence of a gastrogastric fistula development. This was transected with a stapler to prevent any communication.
3. There was an internal hernia where bowel had herniated through Peterson's defect. The bowel hernia had been reduced and then Peterson's defect was repaired.
4. There were adhesions that required lysis of adhesions for greater than 30 minutes in duration.
INDICATIONS:
The patient is a 57-year-old female who was seen in the office in consultation for incisional hernia, as well as abdominal pain. She was warned of the benefits, risks, and alternatives to surgery and wished to proceed with surgery. Please see H&P for details.
PROCEDURE:
The patient was taken to the operating room, placed in the supine position, general anesthesia was induced. Preoperatively briefly identified the patient, procedure, SCIP criteria. Abdomen was prepped and draped in the normal sterile fashion using ChloraPrep. Palmer's point was identified and the incision was made using a 5 mm Visiport with surgery camera. Entrance into the abdomen was achieved and insufflation was carried to 12 mmHg. Inspection of the trocar sites did not reveal evidence of trauma. Another 5 mm port was placed on the left side of the abdomen. The original port was then upsized to a 12 mm port. Immediately it was noted that the patient had a bundle of mesh at her previous repair. This bundle of mesh was then resected with a Harmonic scalpel. The mesh was then sent and delivered as a specimen. Two other 5 mm ports and 12 mm ports were then placed on the right side of the abdomen.
Then a diagnostic laparotomy was ensued. There were significant adhesions underneath the liver that needed to be lysed. These were meticulously lysed without injury to the bowel. Next, once adhesiolysis took place there was evidence of a hiatal hernia. In addition, there was evidence of development of a gastrogastric fistula. There was a connection between the old and new stomach. This could not be cut without causing a gastrotomy. Therefore, the decision was made to staple across this development. A 60 mm purple load was then used to divide this area. This was a reinforced load to divide this area. Once this was done, the bowel was then continuously run; however, there appears to be an internal hernia with significant twisting of the bowel. Due to this, this running of the bowel was aborted and attention was given to the right lower quadrant at the terminal ileum. Next, once the terminal ileum was identified, the bowel was then run distally to proximal. Upon doing this, we were able to reduce the internal hernia that had been present at Peterson's defect. Upon reducing all the bowel, the remainder of the JJ and the Roux limb did not show any twisting. There was, however, a significant Peterson's defect. Upon seeing the Peterson's defect, this was closed using 2-0 Surgitek with Lapra-Ty attached to the end. The defect was successfully eliminated. The bowel was then run and did not show any twisting and laid in the normal anatomical position of antecolic, antegastric Roux-en-Y gastric bypass.
Attention was given to the area where the mesh had been resected. Due to the resection of the gastrogastric fistula, no mesh was used. #1 PDS on a suture passer was then used to close the ventral defect. Inspection was satisfactory. All 12 mm port sites were then closed using 0 Vicryl on a suture passer. The abdomen was desufflated and the ports removed under direct visualization. All port sites were then closed using staples. 0.5% Marcaine mixed with lidocaine was injected at all port sites. At the end of the procedure all needle, sponge, and instrument counts were correct and accounted for. The patient was then extubated and taken to PACU in satisfactory condition.
Approach: Laparoscopic
Having trouble looking for gastrogastric fistula resection code/Internal hernia repair = 43659 (need a code to compare to $$)
PREOPERATIVE DIAGNOSES:
1. RECURRENT ABDOMINAL INCISIONAL HERNIA.
2. ABDOMINAL PAIN.
POSTOPERATIVE DIAGNOSES:
1. RECURRENT ABDOMINAL INCISIONAL HERNIA.
2. INTERNAL HERNIA.
3. HIATAL HERNIA.
4. GASTROGASTRIC FISTULA.
5. ADHESIONS.
OPERATION PERFORMED:
1. DIAGNOSTIC LAPAROSCOPY.
2. GASTROGASTRIC FISTULA RESECTION.
3. INTERNAL HERNIA REPAIR.
4. PRIMARY INCISIONAL HERNIA REPAIR
5. LYSIS OF ADHESIONS ABOUT 30 MINUTES IN DURATION.
SURGEON:
xxxxx
ANESTHESIA:
GENERAL ENDOTRACHEAL.
Complications: None. Estimated blood loss: 25 mL.
FINDINGS:
1. The patient had a hiatal hernia that was appreciated.
2. There was also evidence of a gastrogastric fistula development. This was transected with a stapler to prevent any communication.
3. There was an internal hernia where bowel had herniated through Peterson's defect. The bowel hernia had been reduced and then Peterson's defect was repaired.
4. There were adhesions that required lysis of adhesions for greater than 30 minutes in duration.
INDICATIONS:
The patient is a 57-year-old female who was seen in the office in consultation for incisional hernia, as well as abdominal pain. She was warned of the benefits, risks, and alternatives to surgery and wished to proceed with surgery. Please see H&P for details.
PROCEDURE:
The patient was taken to the operating room, placed in the supine position, general anesthesia was induced. Preoperatively briefly identified the patient, procedure, SCIP criteria. Abdomen was prepped and draped in the normal sterile fashion using ChloraPrep. Palmer's point was identified and the incision was made using a 5 mm Visiport with surgery camera. Entrance into the abdomen was achieved and insufflation was carried to 12 mmHg. Inspection of the trocar sites did not reveal evidence of trauma. Another 5 mm port was placed on the left side of the abdomen. The original port was then upsized to a 12 mm port. Immediately it was noted that the patient had a bundle of mesh at her previous repair. This bundle of mesh was then resected with a Harmonic scalpel. The mesh was then sent and delivered as a specimen. Two other 5 mm ports and 12 mm ports were then placed on the right side of the abdomen.
Then a diagnostic laparotomy was ensued. There were significant adhesions underneath the liver that needed to be lysed. These were meticulously lysed without injury to the bowel. Next, once adhesiolysis took place there was evidence of a hiatal hernia. In addition, there was evidence of development of a gastrogastric fistula. There was a connection between the old and new stomach. This could not be cut without causing a gastrotomy. Therefore, the decision was made to staple across this development. A 60 mm purple load was then used to divide this area. This was a reinforced load to divide this area. Once this was done, the bowel was then continuously run; however, there appears to be an internal hernia with significant twisting of the bowel. Due to this, this running of the bowel was aborted and attention was given to the right lower quadrant at the terminal ileum. Next, once the terminal ileum was identified, the bowel was then run distally to proximal. Upon doing this, we were able to reduce the internal hernia that had been present at Peterson's defect. Upon reducing all the bowel, the remainder of the JJ and the Roux limb did not show any twisting. There was, however, a significant Peterson's defect. Upon seeing the Peterson's defect, this was closed using 2-0 Surgitek with Lapra-Ty attached to the end. The defect was successfully eliminated. The bowel was then run and did not show any twisting and laid in the normal anatomical position of antecolic, antegastric Roux-en-Y gastric bypass.
Attention was given to the area where the mesh had been resected. Due to the resection of the gastrogastric fistula, no mesh was used. #1 PDS on a suture passer was then used to close the ventral defect. Inspection was satisfactory. All 12 mm port sites were then closed using 0 Vicryl on a suture passer. The abdomen was desufflated and the ports removed under direct visualization. All port sites were then closed using staples. 0.5% Marcaine mixed with lidocaine was injected at all port sites. At the end of the procedure all needle, sponge, and instrument counts were correct and accounted for. The patient was then extubated and taken to PACU in satisfactory condition.