Biomesh implant @ stoma construction CPT code needed

nlbarnes

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Escondido, CA
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My plan now was to place a biologic mesh to try to prevent a parastomal hernia as
this patient will have a permanent colostomy. We were right up and
just below the level of the arcuate line, so there was really no
posterior rectus fascia for me to takedown; however, I entered the
plane between the peritoneum and the posterior aspect of the rectus
abdominis muscle. I opened up the spleen widely going at least 3 cm
beyond where my hole for my ostomy was. I then cut an 8 x 8 cm piece
of the stratus that Dr. P was already planning to use, soaked it
bacitracin ointment and then sewed it into the sublay plane that I
created using interrupted 3-0 Vicryl suture. I then identified the
hole in the peritoneum for the ostomy and used an 11 blade to open the
mesh at this point and then extended my mesh incision to make a
cruciate type incision just large enough to allow passage of the
ostomy through and this left the tails of the mesh at the cruciate
keyhole sitting up against the sides of the bowel. I of course did
not sew them in place there. They just rested there. I then passed
the bowel back through the peritoneum and the mesh and then through
the rectus muscle and anterior fascia and off the skin as I had before
and I sewed the mesh all along the edge of the peritoneum with a
running 0 Vicryl suture.
 
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