Can I please get CPT help. If unlisted what would I be comparing to?
The abdomen was prepped and draped in standard fashion. A midline supraumbilical incision was then made and carried through the subcutaneous tissue to the fascia at the base of the umbilicus. The fascia was then incised. Heavy Vicryl was placed on either side of the fascial defect. The Hasson trocar was then entered through the defect into the abdomen. Pneumoperitoneum was established. The abdomen was then examined with the laparoscope. There was no evidence of injury to the bowel secondary to port placement noted. Of note, the liver was quite nodular, concerning for cirrhosis. There was no purulent free fluid. A 5 mm right upper quadrant port was then placed under direct vision. A second 5-mm port was then placed in the left upper quadrant through a separate stab incision under direct vision. The stomach was decompressed with an orogastric tube. It was traced to the duodenal sweep where there severe inflammation at the liver. Some of these inflammatory adhesions were divided with the ligasure device, but the inflammation was quite thick and this approach was abandoned, as blind dissection in this area could be quite dangerous. The decision was then made to attempt to expose the abscess cavity through the lesser sac. The omentum was elevated and divided with the ligasure device. A third working port was then placed in the subxyphoid space to retract the omentum. The stomach was noted to be quite adherent posteriorly to a large inflammatory mass. Using gentle traction on the stomach superiorly by the assistant surgeon, the rind of this mass was exposed and entered. Pus was returned. Cultures were obtained and passed off the field. The opening of the abscess cavity was widened. There was not much liquid pus returned. There were, however, large chunks of thick cheese like material that was pulled out in clumps with the laparoscopic stone forceps. This material was colored black and brown and beige and was tarry in consistency. A sample was sent for pathology. The abscess cavity was irrigated with copious amounts of normal saline. Two 19F blake drains were placed in the abdomen. Each was placed with the tip in the abscess cavity and then brought out through the lateral port and secured to the skin with a 2-0 nylon. The remaining ports were then removed from the abdomen under direct vision. The previously placed Vicryl sutures through the fascial defect were then tied and there was no evidence of hernia noted. The skin was then closed using running 4-0 subcuticular sutures.
The abdomen was prepped and draped in standard fashion. A midline supraumbilical incision was then made and carried through the subcutaneous tissue to the fascia at the base of the umbilicus. The fascia was then incised. Heavy Vicryl was placed on either side of the fascial defect. The Hasson trocar was then entered through the defect into the abdomen. Pneumoperitoneum was established. The abdomen was then examined with the laparoscope. There was no evidence of injury to the bowel secondary to port placement noted. Of note, the liver was quite nodular, concerning for cirrhosis. There was no purulent free fluid. A 5 mm right upper quadrant port was then placed under direct vision. A second 5-mm port was then placed in the left upper quadrant through a separate stab incision under direct vision. The stomach was decompressed with an orogastric tube. It was traced to the duodenal sweep where there severe inflammation at the liver. Some of these inflammatory adhesions were divided with the ligasure device, but the inflammation was quite thick and this approach was abandoned, as blind dissection in this area could be quite dangerous. The decision was then made to attempt to expose the abscess cavity through the lesser sac. The omentum was elevated and divided with the ligasure device. A third working port was then placed in the subxyphoid space to retract the omentum. The stomach was noted to be quite adherent posteriorly to a large inflammatory mass. Using gentle traction on the stomach superiorly by the assistant surgeon, the rind of this mass was exposed and entered. Pus was returned. Cultures were obtained and passed off the field. The opening of the abscess cavity was widened. There was not much liquid pus returned. There were, however, large chunks of thick cheese like material that was pulled out in clumps with the laparoscopic stone forceps. This material was colored black and brown and beige and was tarry in consistency. A sample was sent for pathology. The abscess cavity was irrigated with copious amounts of normal saline. Two 19F blake drains were placed in the abdomen. Each was placed with the tip in the abscess cavity and then brought out through the lateral port and secured to the skin with a 2-0 nylon. The remaining ports were then removed from the abdomen under direct vision. The previously placed Vicryl sutures through the fascial defect were then tied and there was no evidence of hernia noted. The skin was then closed using running 4-0 subcuticular sutures.