Please help with CPT(s) and any modifiers please !! Thanks so much!
Exploratory Lap
Segmental resection of splenic flexure
Repair of umbilical hernia
Upper midline incision made and carried through subcutaneous tissues to fascia which was incised. Abdomen entered, no note of gross pus intra abdominally upon opening. omentum appeared to surround a focal inflammatory mass in the left upper quadrant. Opened with blunt dissection, and frank pus was evacuated. The abscess cavity was involved with the abdominal wall, splenic flexure and omentum. Source not identified. No associated mass and none of the other associated stigmata of perforated cancer which was part of the initial differential. The abdomen was copiously irrigated w/warm sterile normal saline. Resection began with cavity inself. Omental portion was dissected from transverse colon by clamping the omentum and cutting it and ligating it with 3-0 sutures. Done in serial fashing until entire tongue of involved omentum freed. Once more mobile, it appeared to be contiguous with the colon and once this had been mobilized there was an area that appeared to connect to the colon with a small diverticuloum that may have been involved. Decison was made to make a short segmental resection at this time. The splenic flexure was then mobilized starting on the distal aspect by incising the white line of Toldt, and coming up along the pericolic gutter and fividing the spenocolic ligaments and bringing down the omental attachments. This was all done with a combination of ligation and electrocautery. Once the splenic flexure had been completely mobilized, the margins for resection were identified. The last distal margin was then divided w/the GIA stapler and then the proximal margin was also divided likewise with linear cutting stapler. Mesentery to the segment divided with cutting stapler with vascular load. The segment of bowel was passedoff field as specimen. Homostatis was assured by electrocautery and then remaiing segments were then examined which appeared to come into reapproximation easily without evidence of tension. The EEA stapler used to perform and end-to-end anastomosis. Pursestring stapler fired across the distal stump, and the staple line cut and passed off field as specimen. Pursestring tied around the anvil and the fat was then cleared around the present resection segment. The stool then miled prximally in the proximal segment and the longitudinal incision was then made and the EEA spales were entered and brought to the distal end. Colotomy made to allow entrance into the colon was longitudinal colotomy, closed in transverse fashing using vicryl for 1st layer and interrupted for 2nd. staple line oversewn with sutures. Mesenteric defect then closed using 4-0 vicryl. The abdomen again irrigated. small amount of bleeding in the retroperitoneal area of splenic flexure which abated after silk ligature placed. abdom again irrigated. Bowel run from ligament to treitz to the ileocecal valve. No other lesions of note. There were multiple areas of intra loop scarring that was concerning for potential of previous intra abdominal inflammation. Colon examined from cecum to rectum and no other concerning regions were noted. small amount of omentum sucked into hernia defect was resected and hernia sac passed off field as specimen. Midline incision closed, Attention pent on the primary fascial closure at the umbilical aspect of the wound
Exploratory Lap
Segmental resection of splenic flexure
Repair of umbilical hernia
Upper midline incision made and carried through subcutaneous tissues to fascia which was incised. Abdomen entered, no note of gross pus intra abdominally upon opening. omentum appeared to surround a focal inflammatory mass in the left upper quadrant. Opened with blunt dissection, and frank pus was evacuated. The abscess cavity was involved with the abdominal wall, splenic flexure and omentum. Source not identified. No associated mass and none of the other associated stigmata of perforated cancer which was part of the initial differential. The abdomen was copiously irrigated w/warm sterile normal saline. Resection began with cavity inself. Omental portion was dissected from transverse colon by clamping the omentum and cutting it and ligating it with 3-0 sutures. Done in serial fashing until entire tongue of involved omentum freed. Once more mobile, it appeared to be contiguous with the colon and once this had been mobilized there was an area that appeared to connect to the colon with a small diverticuloum that may have been involved. Decison was made to make a short segmental resection at this time. The splenic flexure was then mobilized starting on the distal aspect by incising the white line of Toldt, and coming up along the pericolic gutter and fividing the spenocolic ligaments and bringing down the omental attachments. This was all done with a combination of ligation and electrocautery. Once the splenic flexure had been completely mobilized, the margins for resection were identified. The last distal margin was then divided w/the GIA stapler and then the proximal margin was also divided likewise with linear cutting stapler. Mesentery to the segment divided with cutting stapler with vascular load. The segment of bowel was passedoff field as specimen. Homostatis was assured by electrocautery and then remaiing segments were then examined which appeared to come into reapproximation easily without evidence of tension. The EEA stapler used to perform and end-to-end anastomosis. Pursestring stapler fired across the distal stump, and the staple line cut and passed off field as specimen. Pursestring tied around the anvil and the fat was then cleared around the present resection segment. The stool then miled prximally in the proximal segment and the longitudinal incision was then made and the EEA spales were entered and brought to the distal end. Colotomy made to allow entrance into the colon was longitudinal colotomy, closed in transverse fashing using vicryl for 1st layer and interrupted for 2nd. staple line oversewn with sutures. Mesenteric defect then closed using 4-0 vicryl. The abdomen again irrigated. small amount of bleeding in the retroperitoneal area of splenic flexure which abated after silk ligature placed. abdom again irrigated. Bowel run from ligament to treitz to the ileocecal valve. No other lesions of note. There were multiple areas of intra loop scarring that was concerning for potential of previous intra abdominal inflammation. Colon examined from cecum to rectum and no other concerning regions were noted. small amount of omentum sucked into hernia defect was resected and hernia sac passed off field as specimen. Midline incision closed, Attention pent on the primary fascial closure at the umbilical aspect of the wound