herrera4
Guru
i have colectomy and splenic flexure mobilization but the complication from the stapler-would this just be a mod -22 or additional codes... Thanks for any help
COMPLICATIONS: Small splenic capsular tear easily controlled with cautery and FloSeal. There was initial anastomotic failure of the stapling device requiring re-resection and re-anastomosis.
PROCEDURE: ... ... Additional ports were placed in the right lower quadrant, right mid abdomen, left lower quadrant and left upper quadrant under direct visualization. . The patient was then turned in Trendelenburg and multiple filmy adhesions were noted between the descending and sigmoid colon and the abdominal wall. These were taken down using the LigaSure device. There were diverticula noted up to the distal transverse colon. The white line of Toldt was incised and this was carried superiorly. The splenic flexure was completely mobilized. Once the splenic flexure was completely mobilized the omentum was reflected from the colon to allow for a tension-free anastomosis. ..A point of transection was chosen in the distal transverse colon just proximal to the most distal tic. The rectus muscles were retracted medially and the posterior sheath of the peritoneum was incised and a medium wound protector was placed. The end of the bowel was then grasped with the Babcock and exteriorized. A point of transection was then chosen and the bowel was divided between Allen clamps after cleared of mesentery using ties and ligatures. The bowel was then sized to 28 mm. A pursestring suture of 2-0 Prolene was placed and the 28 mm EEA with a 4.8 mm staple height, anvil was placed in the proximal colon. The pursestring suture was then tied down and additional fatty attachments were divided using the LigaSure device. The bowel was returned to the abdominal cavity. . The operating surgeon then performed a sigmoidoscopy of the stump. There was no bleeding noted and the air leak test was negative. The bowel was then gently dilated to 28 mm. The EEA advanced easily to the end of the staple line. It was inspected to be in the central part of the staple line. After checking orientation the device was closed. The safety stuck at this point. It was then released and the device was then fired Unfortunately at this point the cutter head was in fact, successful in cutting the contained bowel however the staples failed to deploy. At this point the anvil was detached from the stapler. Staples were withdrawn and the edges of the rectosigmoid were elevated. After clearing mesenteric attachments with the LigaSure device, an additional centimeter or so of rectosigmoid was resected using the Endo-GIA with the purple load. The additional specimen was extracted without difficulty. At this point we were unable to identify the anvil which had been placed proximally despite meticulous attempts at visualization laparoscopically. Accordingly, fluoroscopy was brought in and this documented the presence of the anvil in the right upper quadrant. This was noted to be lateral and inferior to the hepatic flexure. The anvil was grasped and was extracted through the left lower quadrant port site.The proximal colon was then prepared for the anastomosis. A pursestring suture of 2-0 Prolene was placed and the 28 mm EEA stapler anvil was placed into the proximal colon. The pursestring suture was tied and the bowel was returned to the abdominal cavity. The operating surgeon then performed a sigmoidoscopy a second time. The staple line was air-tight and the 28 mm EEA was then guided gently to the end of the staple line and the spike was extruded through the staple line. The proximal colon was then docked by . After checking the orientation the device was closed and fired. Two complete anastomotic rings were recovered and the anastomosis was noted to be air-tight. Reinforcing sutures of 2-0 silk were then placed using intracorporeal technique followed by 5 mL of Tisseel. The anastomosis at the completion sigmoidoscopy was noted to be widely patent with no bleeding....
COMPLICATIONS: Small splenic capsular tear easily controlled with cautery and FloSeal. There was initial anastomotic failure of the stapling device requiring re-resection and re-anastomosis.
PROCEDURE: ... ... Additional ports were placed in the right lower quadrant, right mid abdomen, left lower quadrant and left upper quadrant under direct visualization. . The patient was then turned in Trendelenburg and multiple filmy adhesions were noted between the descending and sigmoid colon and the abdominal wall. These were taken down using the LigaSure device. There were diverticula noted up to the distal transverse colon. The white line of Toldt was incised and this was carried superiorly. The splenic flexure was completely mobilized. Once the splenic flexure was completely mobilized the omentum was reflected from the colon to allow for a tension-free anastomosis. ..A point of transection was chosen in the distal transverse colon just proximal to the most distal tic. The rectus muscles were retracted medially and the posterior sheath of the peritoneum was incised and a medium wound protector was placed. The end of the bowel was then grasped with the Babcock and exteriorized. A point of transection was then chosen and the bowel was divided between Allen clamps after cleared of mesentery using ties and ligatures. The bowel was then sized to 28 mm. A pursestring suture of 2-0 Prolene was placed and the 28 mm EEA with a 4.8 mm staple height, anvil was placed in the proximal colon. The pursestring suture was then tied down and additional fatty attachments were divided using the LigaSure device. The bowel was returned to the abdominal cavity. . The operating surgeon then performed a sigmoidoscopy of the stump. There was no bleeding noted and the air leak test was negative. The bowel was then gently dilated to 28 mm. The EEA advanced easily to the end of the staple line. It was inspected to be in the central part of the staple line. After checking orientation the device was closed. The safety stuck at this point. It was then released and the device was then fired Unfortunately at this point the cutter head was in fact, successful in cutting the contained bowel however the staples failed to deploy. At this point the anvil was detached from the stapler. Staples were withdrawn and the edges of the rectosigmoid were elevated. After clearing mesenteric attachments with the LigaSure device, an additional centimeter or so of rectosigmoid was resected using the Endo-GIA with the purple load. The additional specimen was extracted without difficulty. At this point we were unable to identify the anvil which had been placed proximally despite meticulous attempts at visualization laparoscopically. Accordingly, fluoroscopy was brought in and this documented the presence of the anvil in the right upper quadrant. This was noted to be lateral and inferior to the hepatic flexure. The anvil was grasped and was extracted through the left lower quadrant port site.The proximal colon was then prepared for the anastomosis. A pursestring suture of 2-0 Prolene was placed and the 28 mm EEA stapler anvil was placed into the proximal colon. The pursestring suture was tied and the bowel was returned to the abdominal cavity. The operating surgeon then performed a sigmoidoscopy a second time. The staple line was air-tight and the 28 mm EEA was then guided gently to the end of the staple line and the spike was extruded through the staple line. The proximal colon was then docked by . After checking the orientation the device was closed and fired. Two complete anastomotic rings were recovered and the anastomosis was noted to be air-tight. Reinforcing sutures of 2-0 silk were then placed using intracorporeal technique followed by 5 mL of Tisseel. The anastomosis at the completion sigmoidoscopy was noted to be widely patent with no bleeding....
