barbf
New
I've just stared doing general surgery and need some help. Based on the following report, would this be a revision? CPT 34848?
We began through a generous midline incision. Entered the abdomen, lysed adhesions and mobilized the liver. Reflected the liver and was able to get the stomach off this. We then mobilized the greater curvature of the stomach. Isolated the crus, encircled the esophagus at the hiatus. Closed the crus posteriorly using #1 Ethibond. I then removed the Silastic ring and opened the pouch just above the Silastic ring and palpated within it. We placed the anvil of a 25 EEA into the pouch and stapled around the pouch, above the band and along the previous staple line. I then resected the area of the previous band, where I made the gastrotomy. I then created a Roux limb, dividing the jejunum distal to the ligament of Treitz and taking one arcade of vessels. I created a long Roux limb of approx. 75 cm and stapled the base of this using a tan load on the stapler and oversewed the enterotomies using 3-0 PDS and fixed the mesenteric defect using 3-0 silk. I took the end of the Roux limb staple line off and brought the EEA 25 stapler through this and brought it through the side of the jejunum and created an anterior pouch to side jejunal anastomosis with a 25 EEA. Two donuts. I palpated from the inside and stapled across the open end of the Roux limb using a tan load. Endoscopy performed, anastomosis insufflated both as well as the pouch. No narrowing of the GE junction. Then put a G tube into the remnant stomach. A 24 Foley was brought through the right sided stab site, placed into the gastrotomy. Balloon inflated and pursestring tied. Created a Witzel tunnel using 2-0 silk over this and left intracorporeally. Closed with #1 PDS followed by staples.
We began through a generous midline incision. Entered the abdomen, lysed adhesions and mobilized the liver. Reflected the liver and was able to get the stomach off this. We then mobilized the greater curvature of the stomach. Isolated the crus, encircled the esophagus at the hiatus. Closed the crus posteriorly using #1 Ethibond. I then removed the Silastic ring and opened the pouch just above the Silastic ring and palpated within it. We placed the anvil of a 25 EEA into the pouch and stapled around the pouch, above the band and along the previous staple line. I then resected the area of the previous band, where I made the gastrotomy. I then created a Roux limb, dividing the jejunum distal to the ligament of Treitz and taking one arcade of vessels. I created a long Roux limb of approx. 75 cm and stapled the base of this using a tan load on the stapler and oversewed the enterotomies using 3-0 PDS and fixed the mesenteric defect using 3-0 silk. I took the end of the Roux limb staple line off and brought the EEA 25 stapler through this and brought it through the side of the jejunum and created an anterior pouch to side jejunal anastomosis with a 25 EEA. Two donuts. I palpated from the inside and stapled across the open end of the Roux limb using a tan load. Endoscopy performed, anastomosis insufflated both as well as the pouch. No narrowing of the GE junction. Then put a G tube into the remnant stomach. A 24 Foley was brought through the right sided stab site, placed into the gastrotomy. Balloon inflated and pursestring tied. Created a Witzel tunnel using 2-0 silk over this and left intracorporeally. Closed with #1 PDS followed by staples.