ksb0211
Guest
Hoping someone else may have an opinion on this one. The hospital believes this should be coded as 44180 (lap lysis of adhesions) & 20520 (removal of FB in muscle or tendon sheath, simple), but I'm not entirely sold on that.
PREOPERATIVE DIAGNOSIS
1. Abdominal pain, status post motor-vehicle accident.
2. History of ventral hernia repair.
POSTOPERATIVE DIAGNOSIS
Intraabdominal adhesions.
OPERATION PERFORMED
Laparoscopic lysis of adhesions, revision of ventral hernia scar.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR. After induction of adequate general anesthesia, the patient was prepped with DuraPrep and draped sterilely. Perioperative antibiotics have been administered. The initial incision was made. The Optiview port was passed in the right upper quadrant without difficulty. Circumferential view of the peritoneal cavity was unremarkable with no underlying bowel or vascular injury. Omental adhesions were appreciated to the Ventralex mesh, which was in the midline at the umbilicus. There was no evidence of herniation or significant defect. The second trocar was placed in the left upper quadrant. The adhesions were taken down; again, the area was well-surveyed. With this completed and no other intraabdominal pathology appreciated, the abdomen was deflated of CO2. Attention was then turned to the umbilical scar. There was some significant prominence of the tails of the mesh and Prolene, and the possibility of eventual extrusion was entertained. A fishmouth incision was made with a #15 blade. The Prolene sutures were excised as well as some of the tail of the Ventralex mesh. After this was well-excised, the wound was thoroughly irrigated with antibiotic solution. It was then closed in layers with 2-0 Vicryl to the deep tissue, 3-0 Vicryl to the subcutaneous tissue and then 4-0 nylon vertical mattress sutures to the skin. The patient tolerated the procedure and was taken to recovery room in stable condition.
PREOPERATIVE DIAGNOSIS
1. Abdominal pain, status post motor-vehicle accident.
2. History of ventral hernia repair.
POSTOPERATIVE DIAGNOSIS
Intraabdominal adhesions.
OPERATION PERFORMED
Laparoscopic lysis of adhesions, revision of ventral hernia scar.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR. After induction of adequate general anesthesia, the patient was prepped with DuraPrep and draped sterilely. Perioperative antibiotics have been administered. The initial incision was made. The Optiview port was passed in the right upper quadrant without difficulty. Circumferential view of the peritoneal cavity was unremarkable with no underlying bowel or vascular injury. Omental adhesions were appreciated to the Ventralex mesh, which was in the midline at the umbilicus. There was no evidence of herniation or significant defect. The second trocar was placed in the left upper quadrant. The adhesions were taken down; again, the area was well-surveyed. With this completed and no other intraabdominal pathology appreciated, the abdomen was deflated of CO2. Attention was then turned to the umbilical scar. There was some significant prominence of the tails of the mesh and Prolene, and the possibility of eventual extrusion was entertained. A fishmouth incision was made with a #15 blade. The Prolene sutures were excised as well as some of the tail of the Ventralex mesh. After this was well-excised, the wound was thoroughly irrigated with antibiotic solution. It was then closed in layers with 2-0 Vicryl to the deep tissue, 3-0 Vicryl to the subcutaneous tissue and then 4-0 nylon vertical mattress sutures to the skin. The patient tolerated the procedure and was taken to recovery room in stable condition.