rkindlund
Networker
Our general surgeon recently did a hiatal hernia repair along with placement of gastrostomy tube. Dictated this:
He is suggesting a 43653 but this is a separate procedure, so I don't think that would be right. Any suggestions as to how to capture the gastrostomy tube placement? Thank you.
Patient brought to the operating room, prepped and draped
in the standard sterile fashion. He was given 2.5 grams of IV Metrocef on
induction of anesthesia. I began by making a midline incision to just below the
xiphoid to just below the umbilicus, entered the peritoneal cavity without any
difficulty. A Bookwalter retractor was placed. I then reduced the stomach and
duodenum from inside the chest, down to an intra-abdominal location and
proceeded by dissecting the phrenoesophageal membrane until I was able to
identify both the right and left crura. There was a hiatal hernia defect. I
did place a nasogastric tube from anesthesia into position of the stomach, and I
then grasped each side of the crura with the Babcock instrument and then using
pledgets on an 0 Surgilon suture, I reapproximated the crura. At first, I had
placed 2 stitches, but this seemed a little too tight and so after removing the
second stitch, I was able to still admit a fingertip between the esophagus and
the hiatus, and this seemed to be a comfortable position anatomically. Next, to
help keep the stomach intraabdominal, I placed a gastrostomy tube in the antrum
of the stomach. I first took a 3-0 silk suture, made a pursestring. I then
made a small gastrotomy with electrocautery and inserted a gastrotomy tube.
This was a 16-French. This had a 5 mL saline balloon which I deployed and then
tacked the stomach up to the lateral left side of the abdominal wall and the
stomach held nicely in position without much tension and the gastrostomy tube
was secured into position externally on the skin. I did then irrigate with some
warm saline. There was good hemostasis. The sponge and needle count were
correct and I finally closed the wound with 0 looped PDS at the fascial level
and the skin was closed with staples. Patient tolerated the procedure well.
He is suggesting a 43653 but this is a separate procedure, so I don't think that would be right. Any suggestions as to how to capture the gastrostomy tube placement? Thank you.
Patient brought to the operating room, prepped and draped
in the standard sterile fashion. He was given 2.5 grams of IV Metrocef on
induction of anesthesia. I began by making a midline incision to just below the
xiphoid to just below the umbilicus, entered the peritoneal cavity without any
difficulty. A Bookwalter retractor was placed. I then reduced the stomach and
duodenum from inside the chest, down to an intra-abdominal location and
proceeded by dissecting the phrenoesophageal membrane until I was able to
identify both the right and left crura. There was a hiatal hernia defect. I
did place a nasogastric tube from anesthesia into position of the stomach, and I
then grasped each side of the crura with the Babcock instrument and then using
pledgets on an 0 Surgilon suture, I reapproximated the crura. At first, I had
placed 2 stitches, but this seemed a little too tight and so after removing the
second stitch, I was able to still admit a fingertip between the esophagus and
the hiatus, and this seemed to be a comfortable position anatomically. Next, to
help keep the stomach intraabdominal, I placed a gastrostomy tube in the antrum
of the stomach. I first took a 3-0 silk suture, made a pursestring. I then
made a small gastrotomy with electrocautery and inserted a gastrotomy tube.
This was a 16-French. This had a 5 mL saline balloon which I deployed and then
tacked the stomach up to the lateral left side of the abdominal wall and the
stomach held nicely in position without much tension and the gastrostomy tube
was secured into position externally on the skin. I did then irrigate with some
warm saline. There was good hemostasis. The sponge and needle count were
correct and I finally closed the wound with 0 looped PDS at the fascial level
and the skin was closed with staples. Patient tolerated the procedure well.
