Would you agree with 44180 ???
POSTOPERATIVE DIAGNOSIS: Small bowel obstruction.
PROCEDURES:
1. Diagnostic laparoscopy.
2. Laparoscopic lysis of adhesions.
A midline infraumbilical incision was made and carried through subcutaneous tissue to the fascia at the base of the umbilicus, which was grasped and elevated. An incision was then made in the fascia. A heavy Vicryl was placed on either side of the fascial defect. A 5 mm trocar was then entered into the abdomen. Pneumoperitoneum was then established. Intraabdominal examination noted no evidence of lesions and mild distention and apparent adhesional disease in the right lower quadrant. A suprapubic and left lower quadrant port was each placed through separate stab incisions under direct vision. The bowel was then run from the ileocecal valve to the ligament of Treitz. There were no other lesions noted and these adhesions in the mid to distal ileum. The adhesions were then divided. The lumen appeared to be of appropriate diameter at this point. There was no evidence of colonic or cecal lesions. The appendix was visualized and was noted to be normal and was left in situ. Reexamination of the bowel and the remainder of the abdomen noted no other lesions. There is no evidence of bowel injury secondary to port placement. The ports were then removed from the abdomen using direct vision, and the pneumoperitoneum was allowed to resolve. Sutures were then tied. Skin was then closed. Dressings then applied.
POSTOPERATIVE DIAGNOSIS: Small bowel obstruction.
PROCEDURES:
1. Diagnostic laparoscopy.
2. Laparoscopic lysis of adhesions.
A midline infraumbilical incision was made and carried through subcutaneous tissue to the fascia at the base of the umbilicus, which was grasped and elevated. An incision was then made in the fascia. A heavy Vicryl was placed on either side of the fascial defect. A 5 mm trocar was then entered into the abdomen. Pneumoperitoneum was then established. Intraabdominal examination noted no evidence of lesions and mild distention and apparent adhesional disease in the right lower quadrant. A suprapubic and left lower quadrant port was each placed through separate stab incisions under direct vision. The bowel was then run from the ileocecal valve to the ligament of Treitz. There were no other lesions noted and these adhesions in the mid to distal ileum. The adhesions were then divided. The lumen appeared to be of appropriate diameter at this point. There was no evidence of colonic or cecal lesions. The appendix was visualized and was noted to be normal and was left in situ. Reexamination of the bowel and the remainder of the abdomen noted no other lesions. There is no evidence of bowel injury secondary to port placement. The ports were then removed from the abdomen using direct vision, and the pneumoperitoneum was allowed to resolve. Sutures were then tied. Skin was then closed. Dressings then applied.