l1ttle_0ne
Guru
Anyone have any ideas on what to code for this op report?? He states that there was no specific herniation, but he placed mesh. Any help that you can give would be great!
Preoperative Diagnosis: Left groin and lower quadrant abdominal pains
Possible obturator hernia
Postoperative Diagnosis: Same.
Possible appendicitis.
Procedure Performed: Laparoscopic Left Inguinal Hernia Repair—TEPP
(totally preperitoneal approach)
Diagnostic laparoscopy
Laparoscopic appendectomy
Anesthesia: GETA
EBL: Minimal
Fluids: Crystalloids
Drains: None
Specimen: appendix
Indications: Pt. is a year old female with significant pain in the left groin and lower quadrant abdominal areas. There is also some pain in the right pelvic region. Symptoms also consistent with obturator nerve compression is present. Patient presents for diagnostic laparoscopy and to repair any groin hernias. Patient is aware of possible procedures that may need to be done, including appendectomy. Benefits, risk, and alternatives were discussed with the patient, including but not limited to, bowel, bladder, and vessel injuries which may lead to more complications and surgeries. The patient gives written and verbal consent to the procedure.
Findings: Generous obturator foramen, but no specific herniation seen.
The appendix looked a bit inflamed with scarring around it.
No diverticulum noted--Meckel's or colon.
Technique: Patient was taken to the operating room and placed in supine position. SCD stockings were placed on both legs. General anesthesia was administered. Abdomen and groin areas were prepped with Chloraprep solution in usual sterile fashion. Small incision was made in the infraumbilical area, and dissection was carried down to the anterior abdominal fascia. Small incision was made just left of midline. The medial border of the rectus muscle was retracted laterally, exposing the preperitoneal space. Hassan type of camera trocar was placed into the preperitoneal space. Space was insufflated with CO2 gas to 15 mm Hg pressure. The preperitoneal space was further developed, and two working trocars were place in midline--one above the pubis, and the other half way between the pubis and the umbilicus.
Inspection of the groin area showed an some scarring from previous surgery (C-section). The internal inguinal ring was inspected. No herniation was noted at this site. The femoral space was inspected, and once again, no hernia found. The obturator foramen area was inspected. The obturator foramen was generous, but no specific herniation was noted. At this point a 6x6 inch Marlex mesh was brought onto the field. It was cut to appropriate size and shape. The mesh was placed into the preperitoneal space and laid across the inguinal floor. There was excellent coverage of the inguinal floor as well as the femoral space and the obturator foramen. The mesh was secured to the pubic tubercle medially with tacks. Couple other tacks were used to secure the mesh against the abdominal wall. The preperitoneal space was flooded with Ropivacaine for post-operative anesthetic. The preperitoneal space was desufflated of the CO2 gas while holding up the lateral portion of the mesh. The trocars were removed.
Attention was turned to laparoscopy. Using the same infraumbilical trocar site, the peritoneal space was accessed. The cavity was insufflated with CO2 gas to 15 mmHg. Under laparoscopic vision, two other working trocars were placed in the lower abdominal region. Inspection in the RLQ showed the appendix to be long and traversing the posterior pelvis onto the left side. The appendix was curled up, a bit irritated. Decision was made to remove the appendix. The mesoappendix was carefully dissected free and divided between clips. The base of the appendix was dissected free, and then stapled with an Endo-GIA device. The appendix was removed through the infraumbilical trocar. The small bowel was run. No Meckel's or abnormalities were found. The ovaries were normal. No cysts. No torsion. The gallbladder looked normal as well. Inspections showed excellent hemostasis. The trocars were removed and abdomen was desufflated of the CO2 gas. The fascial defect at infraumbilical area was reapproximated with 0-Vicryl sutures. The skin incisions were closed with 4-0 Vicryl sutures in running subcuticular fashion. Benzoin, steri-strips, and sterile dressings were applied. Patient tolerated the surgery well. She was taken to the PACU in stable condition.
Preoperative Diagnosis: Left groin and lower quadrant abdominal pains
Possible obturator hernia
Postoperative Diagnosis: Same.
Possible appendicitis.
Procedure Performed: Laparoscopic Left Inguinal Hernia Repair—TEPP
(totally preperitoneal approach)
Diagnostic laparoscopy
Laparoscopic appendectomy
Anesthesia: GETA
EBL: Minimal
Fluids: Crystalloids
Drains: None
Specimen: appendix
Indications: Pt. is a year old female with significant pain in the left groin and lower quadrant abdominal areas. There is also some pain in the right pelvic region. Symptoms also consistent with obturator nerve compression is present. Patient presents for diagnostic laparoscopy and to repair any groin hernias. Patient is aware of possible procedures that may need to be done, including appendectomy. Benefits, risk, and alternatives were discussed with the patient, including but not limited to, bowel, bladder, and vessel injuries which may lead to more complications and surgeries. The patient gives written and verbal consent to the procedure.
Findings: Generous obturator foramen, but no specific herniation seen.
The appendix looked a bit inflamed with scarring around it.
No diverticulum noted--Meckel's or colon.
Technique: Patient was taken to the operating room and placed in supine position. SCD stockings were placed on both legs. General anesthesia was administered. Abdomen and groin areas were prepped with Chloraprep solution in usual sterile fashion. Small incision was made in the infraumbilical area, and dissection was carried down to the anterior abdominal fascia. Small incision was made just left of midline. The medial border of the rectus muscle was retracted laterally, exposing the preperitoneal space. Hassan type of camera trocar was placed into the preperitoneal space. Space was insufflated with CO2 gas to 15 mm Hg pressure. The preperitoneal space was further developed, and two working trocars were place in midline--one above the pubis, and the other half way between the pubis and the umbilicus.
Inspection of the groin area showed an some scarring from previous surgery (C-section). The internal inguinal ring was inspected. No herniation was noted at this site. The femoral space was inspected, and once again, no hernia found. The obturator foramen area was inspected. The obturator foramen was generous, but no specific herniation was noted. At this point a 6x6 inch Marlex mesh was brought onto the field. It was cut to appropriate size and shape. The mesh was placed into the preperitoneal space and laid across the inguinal floor. There was excellent coverage of the inguinal floor as well as the femoral space and the obturator foramen. The mesh was secured to the pubic tubercle medially with tacks. Couple other tacks were used to secure the mesh against the abdominal wall. The preperitoneal space was flooded with Ropivacaine for post-operative anesthetic. The preperitoneal space was desufflated of the CO2 gas while holding up the lateral portion of the mesh. The trocars were removed.
Attention was turned to laparoscopy. Using the same infraumbilical trocar site, the peritoneal space was accessed. The cavity was insufflated with CO2 gas to 15 mmHg. Under laparoscopic vision, two other working trocars were placed in the lower abdominal region. Inspection in the RLQ showed the appendix to be long and traversing the posterior pelvis onto the left side. The appendix was curled up, a bit irritated. Decision was made to remove the appendix. The mesoappendix was carefully dissected free and divided between clips. The base of the appendix was dissected free, and then stapled with an Endo-GIA device. The appendix was removed through the infraumbilical trocar. The small bowel was run. No Meckel's or abnormalities were found. The ovaries were normal. No cysts. No torsion. The gallbladder looked normal as well. Inspections showed excellent hemostasis. The trocars were removed and abdomen was desufflated of the CO2 gas. The fascial defect at infraumbilical area was reapproximated with 0-Vicryl sutures. The skin incisions were closed with 4-0 Vicryl sutures in running subcuticular fashion. Benzoin, steri-strips, and sterile dressings were applied. Patient tolerated the surgery well. She was taken to the PACU in stable condition.