ksb0211
Guest
Ok. I'm hoping for another set of eyes. Having trouble coming up with something that seems to work for this. Others have recommended unlisted 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum)
PREOPERATIVE DIAGNOSIS
Postoperative incisional pain status post laparoscopic ventral incisional hernia repair
POSTOPERATIVE DIAGNOSIS
Adhesions, retained suture.
OPERATION PERFORMED
Diagnostic laparoscopy, lysis of adhesions and removal of suture.
PROCEDURE
The patient was brought to the operating room. After attainment of sufficient general anesthesia, he was pretreated with antibiotics and prepped and draped in the usual sterile fashion. Made a 10 mm incision in the right upper quadrant. Got into the abdominal cavity with Veress needle and subsequently insufflated 14 mmHg. Placed a 5 mm port and saw there were some adhesions medially. Placed a 5 mm port in the right hypogastrium and then started taking down the adhesions which just came right off that Seprafilm. Placed an additional 5 down the left lower quadrant and took all the adhesions down off the mesh by sweeping them off the mesh. Some of them were more adherent than others requiring a little bit of gentle laparoscopic Metzenbaum. We then identified the suture which seemed to be causing the patient's pain, we pulled it down and excised it. We checked for adequate hemostasis, which we had and then turned our attention to closure. We closed with running subcuticular sutures of 4-0 Vicryl, followed by running subcuticular suture of 4-0 Vicryl. Sterile dressing was applied.
PREOPERATIVE DIAGNOSIS
Postoperative incisional pain status post laparoscopic ventral incisional hernia repair
POSTOPERATIVE DIAGNOSIS
Adhesions, retained suture.
OPERATION PERFORMED
Diagnostic laparoscopy, lysis of adhesions and removal of suture.
PROCEDURE
The patient was brought to the operating room. After attainment of sufficient general anesthesia, he was pretreated with antibiotics and prepped and draped in the usual sterile fashion. Made a 10 mm incision in the right upper quadrant. Got into the abdominal cavity with Veress needle and subsequently insufflated 14 mmHg. Placed a 5 mm port and saw there were some adhesions medially. Placed a 5 mm port in the right hypogastrium and then started taking down the adhesions which just came right off that Seprafilm. Placed an additional 5 down the left lower quadrant and took all the adhesions down off the mesh by sweeping them off the mesh. Some of them were more adherent than others requiring a little bit of gentle laparoscopic Metzenbaum. We then identified the suture which seemed to be causing the patient's pain, we pulled it down and excised it. We checked for adequate hemostasis, which we had and then turned our attention to closure. We closed with running subcuticular sutures of 4-0 Vicryl, followed by running subcuticular suture of 4-0 Vicryl. Sterile dressing was applied.