coder25
Guru
My doc performed a dx. lap with washout, partial gastrectomy, EGD x1, and reinsertion of percutaneous endoscopic gastrostomy feeding tube (previous one placed two days ago, however, pt pulled it out).
Descript of OP:
Following insertion of Veress needle with low insufflation pressures were achieved with good pneumoperitoneum. The Veress needle was withdrawn and a 5 mm port and trocar inserted followed by insertion of laparoscope, which was used to evaluate the intra-abd. cavity for any indication of trocar injuries directed towards the site of prior PEG tube insertion without any indication of active extravasation. The remaining two 5 mm trocars were inserted under direct visualization with 11 blade scalpel used for skin incision and intra-abd washout was performed. THe decision was then made to resect prior PEG insertion site, which was accomplished using two Echelon blue load staple cartridges. This was performed without difficulty and attention was then directed towards reinsertion of PEG tube. EGD was performed and esophagus as well as stomach, well visualized w/o pathology. Endoscopic snare was then inserted and catheter enclosed, introducing needle inserted percutaneously under both endoscopic and laparoscopic direct visualization. A snare was used to secure the catheter followed by insertion of guidewire through the mouth at which time PEG was attached and brought down into the stomach and through the abdominal wall under standard fashion. PEG attachment site was then evaluated, laparoscopically, and fascial closure of the 12 mm umbilical port site was closed.
I am not sure what to use for the gastrectomy. He only excised the prior PEG insertion site.
I plan on using 43241 for the snare PEG. Is this correct? What about the washout?
Thanks in advance for your help!
Descript of OP:
Following insertion of Veress needle with low insufflation pressures were achieved with good pneumoperitoneum. The Veress needle was withdrawn and a 5 mm port and trocar inserted followed by insertion of laparoscope, which was used to evaluate the intra-abd. cavity for any indication of trocar injuries directed towards the site of prior PEG tube insertion without any indication of active extravasation. The remaining two 5 mm trocars were inserted under direct visualization with 11 blade scalpel used for skin incision and intra-abd washout was performed. THe decision was then made to resect prior PEG insertion site, which was accomplished using two Echelon blue load staple cartridges. This was performed without difficulty and attention was then directed towards reinsertion of PEG tube. EGD was performed and esophagus as well as stomach, well visualized w/o pathology. Endoscopic snare was then inserted and catheter enclosed, introducing needle inserted percutaneously under both endoscopic and laparoscopic direct visualization. A snare was used to secure the catheter followed by insertion of guidewire through the mouth at which time PEG was attached and brought down into the stomach and through the abdominal wall under standard fashion. PEG attachment site was then evaluated, laparoscopically, and fascial closure of the 12 mm umbilical port site was closed.
I am not sure what to use for the gastrectomy. He only excised the prior PEG insertion site.
I plan on using 43241 for the snare PEG. Is this correct? What about the washout?
Thanks in advance for your help!
