nlbarnes
Expert
Doc is using 43659 but I can't help but think there might be something else appending with modifer 52, such as 43653. I'm super tired.
Again, after quite a long time of dissection, more than about 45 minutes, we were finally
able to identify the remnant stomach. This was not much able to be
dissected free as it was densely adherent to the liver, so we did
finally able to identify the greater curvature of the remnant stomach.
At this point, we used 2-0 Surgidac suture to place two sutures on the
greater curvature of the stomach and then we placed a 15 trocar in the
left upper quadrant. We used the Harmonic scalpel to make a
gastrotomy in the stomach and then guided the 15 trocar into the
stomach at this location and then hoisted two 2-0 Surgidac sutures,
which we then passed through transabdominally with the Endo Close
device. We hoisted this up against the abdominal wall. I refer you
to Dr. Reidel's dictation about the ERCP which was done through the 15
mm trocar. Once they were completed, we removed the suspension
sutures and then closed the gastrotomy using 2 layer closure with 2-0
Polysorb suture and 2-0 Surgidac suture. When this was completed, we
did look around. Again, as I mentioned, we tried to evaluate the
gallbladder and the right upper quadrant, but there were too many
adhesions from the previous surgery and copious inflammation from the
gallbladder, so was not able to be visualized.
Again, after quite a long time of dissection, more than about 45 minutes, we were finally
able to identify the remnant stomach. This was not much able to be
dissected free as it was densely adherent to the liver, so we did
finally able to identify the greater curvature of the remnant stomach.
At this point, we used 2-0 Surgidac suture to place two sutures on the
greater curvature of the stomach and then we placed a 15 trocar in the
left upper quadrant. We used the Harmonic scalpel to make a
gastrotomy in the stomach and then guided the 15 trocar into the
stomach at this location and then hoisted two 2-0 Surgidac sutures,
which we then passed through transabdominally with the Endo Close
device. We hoisted this up against the abdominal wall. I refer you
to Dr. Reidel's dictation about the ERCP which was done through the 15
mm trocar. Once they were completed, we removed the suspension
sutures and then closed the gastrotomy using 2 layer closure with 2-0
Polysorb suture and 2-0 Surgidac suture. When this was completed, we
did look around. Again, as I mentioned, we tried to evaluate the
gallbladder and the right upper quadrant, but there were too many
adhesions from the previous surgery and copious inflammation from the
gallbladder, so was not able to be visualized.