manib84@yahoo.com
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I am having some trouble finding the CPT code for this procedure.
The Procedure is as follows:
An elliptical incision was made surrounding the external opening on the anterior abdominal wall. After making incision with scalpel, dissection was carried down to the level of the fascia and because of the patient's previous surgery and significant scarring, considerable tome was spent dissecting the small bowel away fromt the fascia and this was eventually accomplished using Metzenbaum scissors and electrocautery. I had to mobilize the small bowel for several centimeters proximally and distally to ensure that I was ab;le to achoieve a tension-free anastomsis and to endsure and identlf6y proper anatomy in the process. Once I was able to identify the stomach and the limbs of the jejunum, i then excised the fistulous tract at the level of the internal opening in the jejunum. I had to get back to healthy, unscarred bowel and this led to a 4-5 cm opening involving the stomach and jejunum. I oriented the GI tract appropriately and closed the gastric portion vertically with interrupted 3-0 silks, and I closed the jejunal portion on the antimesenteric border in the alignment of the bowel itself. I took great care to make sure that the gastrojejunal anastomosis was not narrowed, and did not appear to be so. The NG tube was properly positioned, and I insufflated the area with saline to ensure that there was no air leak to at the anastomosis and none was identified. I was therefore satisfied that the single air interrupted 3-0 silk closure was adequate. I washed out the peritoneal cavity with saline, and I then mobilized the fascia ledges circumferentially in preparation for the closure. The fascia was closed with interrupted 0 Vicryl and after irrigating out the subcutaneous tissues, I packed the wound open with saline Kerlix. Procedure was tolerated well without complications. Sponge and instruments counts correct.
I've reviewed several procedures and would like to know what anyone willing to assist thinks.
The Procedure is as follows:
An elliptical incision was made surrounding the external opening on the anterior abdominal wall. After making incision with scalpel, dissection was carried down to the level of the fascia and because of the patient's previous surgery and significant scarring, considerable tome was spent dissecting the small bowel away fromt the fascia and this was eventually accomplished using Metzenbaum scissors and electrocautery. I had to mobilize the small bowel for several centimeters proximally and distally to ensure that I was ab;le to achoieve a tension-free anastomsis and to endsure and identlf6y proper anatomy in the process. Once I was able to identify the stomach and the limbs of the jejunum, i then excised the fistulous tract at the level of the internal opening in the jejunum. I had to get back to healthy, unscarred bowel and this led to a 4-5 cm opening involving the stomach and jejunum. I oriented the GI tract appropriately and closed the gastric portion vertically with interrupted 3-0 silks, and I closed the jejunal portion on the antimesenteric border in the alignment of the bowel itself. I took great care to make sure that the gastrojejunal anastomosis was not narrowed, and did not appear to be so. The NG tube was properly positioned, and I insufflated the area with saline to ensure that there was no air leak to at the anastomosis and none was identified. I was therefore satisfied that the single air interrupted 3-0 silk closure was adequate. I washed out the peritoneal cavity with saline, and I then mobilized the fascia ledges circumferentially in preparation for the closure. The fascia was closed with interrupted 0 Vicryl and after irrigating out the subcutaneous tissues, I packed the wound open with saline Kerlix. Procedure was tolerated well without complications. Sponge and instruments counts correct.
I've reviewed several procedures and would like to know what anyone willing to assist thinks.