ksb0211
Guest
Just hoping that someone might be able to point me in the right direction on this one. I'm hoping that I can avoid an unlisted code.
Thanks for any input or thoughts on this one.
PREOPERATIVE DIAGNOSIS
Parastomal hernia. 569.89
POSTOPERATIVE DIAGNOSIS
Parastomal hernia. 569.89
OPERATION PERFORMED
Laparoscopic repair of parastomal hernia utilizing AlloMax graft in Sugarbaker technique.
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. The patient has a permanent colostomy status post APR for carcinoma of the rectum. She has developed a significant left lower quadrant parastomal hernia. Repair is planned.
The initial incision was made in the right upper quadrant with a #15 blade. The Optiview port was utilized. The abdominal cavity was entered utilizing the Optiview technique. There was no underlying bowel or vascular injury. Two additional ports were placed, another 5 port and a 10/12 port. With this completed, the patient was noted to have significant omental adhesions which were taken down from the midline. Once this was done I was able to better visualize the hernia. There were adhesions of colon to the abdominal wall in the left lower quadrant. These were taken down. The bowel was reduced from the hernia. The hernia defect was noted to be significant, probably 6 cm in diameter. The bowel was eventually well mobilized. Once this was completed, the hernia defect was closed somewhat utilizing a suture passer and interrupted sutures of #1 PDS. The defect was decreased in size significantly, though it did not impinge significantly on the bowel itself. The decision was then to utilize an AlloMax graft. The Sugarbaker Baker technique was utilized. The 13 x 15 cm graft was passed intraabdominally. The ProTack stapling device was utilized and the graft was secured laterally to the abdominal wall, bringing the residual left colon up to the level of the wall. The graft then covered the site of the hernia and draped towards the midline. This was all secured well with a double row of the ProTack stapler. Stay sutures of 2-0 Prolene were also utilized to help secure the graft and maintain its position. Once this was completed, the abdominal cavity was inspected for hemostasis. There was no evidence of bowel or vascular injury. The 10/12 port site was closed with 0-Monocryl suture. The wounds were then closed with clips. Dry sterile dressings were applied as well as a binder. The patient tolerated the procedure and was taken to recovery room in stable condition.
Thanks for any input or thoughts on this one.
PREOPERATIVE DIAGNOSIS
Parastomal hernia. 569.89
POSTOPERATIVE DIAGNOSIS
Parastomal hernia. 569.89
OPERATION PERFORMED
Laparoscopic repair of parastomal hernia utilizing AlloMax graft in Sugarbaker technique.
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. The patient has a permanent colostomy status post APR for carcinoma of the rectum. She has developed a significant left lower quadrant parastomal hernia. Repair is planned.
The initial incision was made in the right upper quadrant with a #15 blade. The Optiview port was utilized. The abdominal cavity was entered utilizing the Optiview technique. There was no underlying bowel or vascular injury. Two additional ports were placed, another 5 port and a 10/12 port. With this completed, the patient was noted to have significant omental adhesions which were taken down from the midline. Once this was done I was able to better visualize the hernia. There were adhesions of colon to the abdominal wall in the left lower quadrant. These were taken down. The bowel was reduced from the hernia. The hernia defect was noted to be significant, probably 6 cm in diameter. The bowel was eventually well mobilized. Once this was completed, the hernia defect was closed somewhat utilizing a suture passer and interrupted sutures of #1 PDS. The defect was decreased in size significantly, though it did not impinge significantly on the bowel itself. The decision was then to utilize an AlloMax graft. The Sugarbaker Baker technique was utilized. The 13 x 15 cm graft was passed intraabdominally. The ProTack stapling device was utilized and the graft was secured laterally to the abdominal wall, bringing the residual left colon up to the level of the wall. The graft then covered the site of the hernia and draped towards the midline. This was all secured well with a double row of the ProTack stapler. Stay sutures of 2-0 Prolene were also utilized to help secure the graft and maintain its position. Once this was completed, the abdominal cavity was inspected for hemostasis. There was no evidence of bowel or vascular injury. The 10/12 port site was closed with 0-Monocryl suture. The wounds were then closed with clips. Dry sterile dressings were applied as well as a binder. The patient tolerated the procedure and was taken to recovery room in stable condition.