daniellebailey2244@gmail.com
Networker
I am having a hard time coding this procedure can anyone lend me a helping hand?? Do I code with mesh?
Preoperative Diagnosis: Bilateral inguinal hernias
Postoperative Diagnosis: Bilateral inguinal hernias
Procedure: Laparoscopic bilateral inguinal hernia repair
Indications:
The patient is a pleasant 65-year old gentleman who complains of pain in both groins with
activity. He states that the right side protrudes more than the left side; however, on exam he is
noted to have bilateral hernias. He has no history of previous hernia repair. He denies
constipation, chronic cough or difficulty voiding. He consented to laparoscopic repair.
Findings:
Moderate right direct and small left indirect inguinal hernias.
Procedure:
Patient was placed on the operating table in the supine position. After induction of general
anesthesia, the patient was prepped and draped in the usual manner. A small, infraumbilical
incision was then made slightly to the right of midline and carried down to the fascia of the rectus
muscle. The anterior fascia was then sharply entered and the space between the two leaves of
fascia was dissected free. At this point, a balloon dilator was inserted just beneath the anterior
fascia of the rectus sheath and directed towards the pubic tubercle.
Under direct visualization, the balloon dilator was inflated ensuring proper placement. The
balloon dilator was then directed into both right and left groins to dissect the preperitoneal space.
After adequate dissection, the balloon dilator and camera were removed, and a 12-mm camera
port was placed. Again, under direct visualization, the pre-peritoneal space was insufflated, and
a right lower quadrant 5-mm trocar was placed. A grasper was then used to bluntly dissect both
groins, and a second 5-mm port was placed into the left lower abdomen into the preperitoneal
space. A very small, indirect hernia was identified on the left side and was reduced with blunt
dissection.
Attention was then directed at the right side, and a moderate-sized direct inguinal hernia was
identified on the right side. It was reduced and the spermatic cord evaluated, and the peritoneum
reduced back into the abdominal cavity. After we were satisfied with the dissection and ensured
that there were no other hernias to evaluate, a piece of pre-formed Prolene mesh was inserted
into the left pelvis. This piece of mesh was positioned in an appropriate manner to cover the
direct and indirect defects. A second piece of extra large mesh was then placed through the
camera port into the right pelvis, again positioned to protect against direct and indirect inguinal
hernias as well as femoral hernias.
The incisions were then closed. The anterior fascia at the rectus sheath was closed with a single
#2-0 Vicryl suture in interrupted fashion, and the skin edges reapproximated using interrupted #4-
0 Vicryl suture in subcuticular fashion.
Preoperative Diagnosis: Bilateral inguinal hernias
Postoperative Diagnosis: Bilateral inguinal hernias
Procedure: Laparoscopic bilateral inguinal hernia repair
Indications:
The patient is a pleasant 65-year old gentleman who complains of pain in both groins with
activity. He states that the right side protrudes more than the left side; however, on exam he is
noted to have bilateral hernias. He has no history of previous hernia repair. He denies
constipation, chronic cough or difficulty voiding. He consented to laparoscopic repair.
Findings:
Moderate right direct and small left indirect inguinal hernias.
Procedure:
Patient was placed on the operating table in the supine position. After induction of general
anesthesia, the patient was prepped and draped in the usual manner. A small, infraumbilical
incision was then made slightly to the right of midline and carried down to the fascia of the rectus
muscle. The anterior fascia was then sharply entered and the space between the two leaves of
fascia was dissected free. At this point, a balloon dilator was inserted just beneath the anterior
fascia of the rectus sheath and directed towards the pubic tubercle.
Under direct visualization, the balloon dilator was inflated ensuring proper placement. The
balloon dilator was then directed into both right and left groins to dissect the preperitoneal space.
After adequate dissection, the balloon dilator and camera were removed, and a 12-mm camera
port was placed. Again, under direct visualization, the pre-peritoneal space was insufflated, and
a right lower quadrant 5-mm trocar was placed. A grasper was then used to bluntly dissect both
groins, and a second 5-mm port was placed into the left lower abdomen into the preperitoneal
space. A very small, indirect hernia was identified on the left side and was reduced with blunt
dissection.
Attention was then directed at the right side, and a moderate-sized direct inguinal hernia was
identified on the right side. It was reduced and the spermatic cord evaluated, and the peritoneum
reduced back into the abdominal cavity. After we were satisfied with the dissection and ensured
that there were no other hernias to evaluate, a piece of pre-formed Prolene mesh was inserted
into the left pelvis. This piece of mesh was positioned in an appropriate manner to cover the
direct and indirect defects. A second piece of extra large mesh was then placed through the
camera port into the right pelvis, again positioned to protect against direct and indirect inguinal
hernias as well as femoral hernias.
The incisions were then closed. The anterior fascia at the rectus sheath was closed with a single
#2-0 Vicryl suture in interrupted fashion, and the skin edges reapproximated using interrupted #4-
0 Vicryl suture in subcuticular fashion.