rrrobinson05
Contributor
I'm looking for guidance on this one. I looked at both 43334 and 32124. I just don't know about this one. If anyone has experience with this, your input would be appreciated.
Op Note:
(Patient) is a 15 y.o. female presenting with recurrent CDH picked up on her yearly surveillance xray Weight: 54.9 kg (121 lb 0.5 oz)
Operative Details: Jasmine was brought to the operating room where they underwent general anesthesia. The area of the left chest was then prepped and draped in the usual fashion. A 5mm port was placed beneath the scapula within the prior thoracotomy incision scar. The scope was inserted and we encountered a fair amount of scar tissue from the prior procedure. We were able to clear adhesions well enough to place 2 additional ports under direct vision. We then turned our attention to the diaphragm. I did an hour of lysis of adhesions in order to free the lung from the chest wall and from the diaphragm. Given the significant amount of scar tissue I did not ultimately feel comfortable enough with the anatomy to complete the repair thoracoscopically. This point we chose to open the chest at the same site as the prior thoracotomy incision. An open fashion we continued to sort out anatomy and adhesions and ultimately were able to identify small posterior lateral fascial defects with omental contents. The abdominal contents were reduced. We then used Ethibond sutures to close the gap between the diaphragm and the thoracic wall. These were brought through the chest wall into stab incisions externally and tied down externally. A chest tube was inserted and we proceeded with closure. The ribs of the thoracotomy incision were reapproximated using figure-of-eight Vicryl sutures. Also layers were reapproximated using 2-0 Vicryl. Subcutaneous tissue was closed with Vicryl and the skin was closed with Monocryl. The 2 additional thoracoscopy incisions were closed with a deep layer of Vicryl and the skin layer Monocryl. The chest tube was sutured in place with nylon.
The area was cleaned and dried and sterile dressings were applied. The patient was awakened, extubated, and taken to the recovery room in satisfactory condition.
Op Note:
(Patient) is a 15 y.o. female presenting with recurrent CDH picked up on her yearly surveillance xray Weight: 54.9 kg (121 lb 0.5 oz)
Operative Details: Jasmine was brought to the operating room where they underwent general anesthesia. The area of the left chest was then prepped and draped in the usual fashion. A 5mm port was placed beneath the scapula within the prior thoracotomy incision scar. The scope was inserted and we encountered a fair amount of scar tissue from the prior procedure. We were able to clear adhesions well enough to place 2 additional ports under direct vision. We then turned our attention to the diaphragm. I did an hour of lysis of adhesions in order to free the lung from the chest wall and from the diaphragm. Given the significant amount of scar tissue I did not ultimately feel comfortable enough with the anatomy to complete the repair thoracoscopically. This point we chose to open the chest at the same site as the prior thoracotomy incision. An open fashion we continued to sort out anatomy and adhesions and ultimately were able to identify small posterior lateral fascial defects with omental contents. The abdominal contents were reduced. We then used Ethibond sutures to close the gap between the diaphragm and the thoracic wall. These were brought through the chest wall into stab incisions externally and tied down externally. A chest tube was inserted and we proceeded with closure. The ribs of the thoracotomy incision were reapproximated using figure-of-eight Vicryl sutures. Also layers were reapproximated using 2-0 Vicryl. Subcutaneous tissue was closed with Vicryl and the skin was closed with Monocryl. The 2 additional thoracoscopy incisions were closed with a deep layer of Vicryl and the skin layer Monocryl. The chest tube was sutured in place with nylon.
The area was cleaned and dried and sterile dressings were applied. The patient was awakened, extubated, and taken to the recovery room in satisfactory condition.