Agrant77
New
Am I correct this is only 44626? I do not see a separate incision for the hernia repair 49621.
A midline incision was made with a #10 blade following his previous incision scar and dissection through the subcutaneous midline was performed electrocautery opened the fascia at the length of the incision. Limited adhesions of the small bowel were carefully taken down with Metzenbaum scissors. Overall the bowel appeared healthy. Patient was placed in slight Trendelenburg position. The rectal stump was identified by the previously placed Prolene suture.
The colostomy was mobilized by incising skin circumferentially around the ostomy site and carefully dissected through subcutaneous tissue layers to free the ostomy from the abdominal wall and structures. Once the stomach was completely freed the end of the colostomy was removed by firing a GIA 75 stapler approximately 5 cm above the previous and the segment was sent to pathology
Patient had developed a parastomal hernia measuring approximately 8 cm in vertical dimension by 6 cm in horizontal dimension. The fascia at the hernia site was carefully reapproximated with a series of interrupted 0 Prolene sutures. An underlay biologic mesh repair was then performed to further reinforce the hernia site. A Stratus 10 x 10 cm was sewn into place using interrupted Prolene sutures. This was fixed laterally approximately 3 cm past previous fascial edge as well as superiorly and inferiorly. Stapled end of the descending colon was then prepared for anastomosis. Pursestring sutures placed above the staple line and staple line amputated with scissors. Good blood flow to the and mucosa was assured. Segment was dilated with a 25 2831 mm dilator. A 31 mm EEA was chosen to perform the anastomosis. The anvil for the stapler was placed within the segment and secured with the pursestring.
The rectal stump was then carefully freed from any surrounding adhesions and prepared for anastomosis. From below the anus was dilated to 2 fingerbreadths and then the rectal segment was carefully serially dilated with a 25 2831 and 33 mm dilator. The 31 mm EEA stapler was then carefully passed per anus to the stapled end of the rectal stump. Here the spike was advanced just anterior to the previous staple line. Once fully deployed the anvil was connected and the stapler carefully closed to the appropriate tightness. Stapler was fired creating a 31 mm circular anastomosis. The proximal and distal donuts were inspected and were complete. The pelvis was then filled with saline and insufflation was provided per rectum with a rigid sigmoidoscope with the anastomosis under submersion to look for any sign of air leak. Segment insufflated well above the staple line and no sign of air leak was present. All fluid was suctioned out and hemostasis was assured. Irrigation was performed of the right lateral abdomen left lateral abdomen and pelvis once more and all fluid was suctioned out. The previously attached biologic mesh was now secured to the right side of the midline incision with transfascial 0 Prolene sutures. The midline was then closed using a running 0 PDS suture. Irrigation the skin and subcu was again performed and the skin reapproximated with skin staples. Sterile tape and gauze dressings were placed.
A midline incision was made with a #10 blade following his previous incision scar and dissection through the subcutaneous midline was performed electrocautery opened the fascia at the length of the incision. Limited adhesions of the small bowel were carefully taken down with Metzenbaum scissors. Overall the bowel appeared healthy. Patient was placed in slight Trendelenburg position. The rectal stump was identified by the previously placed Prolene suture.
The colostomy was mobilized by incising skin circumferentially around the ostomy site and carefully dissected through subcutaneous tissue layers to free the ostomy from the abdominal wall and structures. Once the stomach was completely freed the end of the colostomy was removed by firing a GIA 75 stapler approximately 5 cm above the previous and the segment was sent to pathology
Patient had developed a parastomal hernia measuring approximately 8 cm in vertical dimension by 6 cm in horizontal dimension. The fascia at the hernia site was carefully reapproximated with a series of interrupted 0 Prolene sutures. An underlay biologic mesh repair was then performed to further reinforce the hernia site. A Stratus 10 x 10 cm was sewn into place using interrupted Prolene sutures. This was fixed laterally approximately 3 cm past previous fascial edge as well as superiorly and inferiorly. Stapled end of the descending colon was then prepared for anastomosis. Pursestring sutures placed above the staple line and staple line amputated with scissors. Good blood flow to the and mucosa was assured. Segment was dilated with a 25 2831 mm dilator. A 31 mm EEA was chosen to perform the anastomosis. The anvil for the stapler was placed within the segment and secured with the pursestring.
The rectal stump was then carefully freed from any surrounding adhesions and prepared for anastomosis. From below the anus was dilated to 2 fingerbreadths and then the rectal segment was carefully serially dilated with a 25 2831 and 33 mm dilator. The 31 mm EEA stapler was then carefully passed per anus to the stapled end of the rectal stump. Here the spike was advanced just anterior to the previous staple line. Once fully deployed the anvil was connected and the stapler carefully closed to the appropriate tightness. Stapler was fired creating a 31 mm circular anastomosis. The proximal and distal donuts were inspected and were complete. The pelvis was then filled with saline and insufflation was provided per rectum with a rigid sigmoidoscope with the anastomosis under submersion to look for any sign of air leak. Segment insufflated well above the staple line and no sign of air leak was present. All fluid was suctioned out and hemostasis was assured. Irrigation was performed of the right lateral abdomen left lateral abdomen and pelvis once more and all fluid was suctioned out. The previously attached biologic mesh was now secured to the right side of the midline incision with transfascial 0 Prolene sutures. The midline was then closed using a running 0 PDS suture. Irrigation the skin and subcu was again performed and the skin reapproximated with skin staples. Sterile tape and gauze dressings were placed.