midnight1995
Networker
I am in need of some help: Op note is below - Thank you in Advance for any help.
Coded as followed: 49020 and 49320
Operation:
Diagnostic laparoscopy
Lysis of adhesions
Drainage of intra-abdominal abscess
Technique:
Patient brought back to the operating room induced under anesthesia. Foley catheter was attempted and provided difficult therefore I had to place a coude catheter was able to get into the bladder and the bladder was decompressed with over 900 cc of urine. Abdomen was than prepped and draped sterile fashion. Timeout performed correct patient procedure agreed upon male. Left upper quadrant stab incision made Visiport used to enter the abdomen was insufflated. 2 other ports were placed and patient was placed headown and rotated to the left. Stated by finding the cecum and terminal ileum and running the small bowel backwards. Eventually at met a trnsition point and the site of the obsturction which was the small bowel plastered to the left sigmoid colon and diverticulitis. This area was taken down using combination of blunt and sharp disscetion and suction irrigator and there was a abscess pocket that was suctioned out. There were multiple loops of bowel stuck to this very hard dense abscess pocket. Care was taken not to make any enterotomies. The area was copiously irrigated and suctioned out and eventually all the small bowel was able to be released from the abscess cavity. I again ran the bowel backwards from the terminal ileum and cecum to the site of the obstruction and got passed all the parts of the bowel that had been stuck and found the very dilated proximal bowel that was proximal to the obstruction. At this point when I was satisfied that the obstruction was relieved, I washed out the abdomen copiously irrigated with multiple liters of saline and suctioned out. All areas of small bowel that were taken off the abscess were inspected without any signs of enterotomies or leakage of GI contents. Because there was an abscess from diverticular disease a drain was left in the pelvis and placed next to the sigmoid colon. It was secured to the skin with nylon. Incisions were closed in standard fashion and patient was taken to the recovery room.
Coded as followed: 49020 and 49320
Operation:
Diagnostic laparoscopy
Lysis of adhesions
Drainage of intra-abdominal abscess
Technique:
Patient brought back to the operating room induced under anesthesia. Foley catheter was attempted and provided difficult therefore I had to place a coude catheter was able to get into the bladder and the bladder was decompressed with over 900 cc of urine. Abdomen was than prepped and draped sterile fashion. Timeout performed correct patient procedure agreed upon male. Left upper quadrant stab incision made Visiport used to enter the abdomen was insufflated. 2 other ports were placed and patient was placed headown and rotated to the left. Stated by finding the cecum and terminal ileum and running the small bowel backwards. Eventually at met a trnsition point and the site of the obsturction which was the small bowel plastered to the left sigmoid colon and diverticulitis. This area was taken down using combination of blunt and sharp disscetion and suction irrigator and there was a abscess pocket that was suctioned out. There were multiple loops of bowel stuck to this very hard dense abscess pocket. Care was taken not to make any enterotomies. The area was copiously irrigated and suctioned out and eventually all the small bowel was able to be released from the abscess cavity. I again ran the bowel backwards from the terminal ileum and cecum to the site of the obstruction and got passed all the parts of the bowel that had been stuck and found the very dilated proximal bowel that was proximal to the obstruction. At this point when I was satisfied that the obstruction was relieved, I washed out the abdomen copiously irrigated with multiple liters of saline and suctioned out. All areas of small bowel that were taken off the abscess were inspected without any signs of enterotomies or leakage of GI contents. Because there was an abscess from diverticular disease a drain was left in the pelvis and placed next to the sigmoid colon. It was secured to the skin with nylon. Incisions were closed in standard fashion and patient was taken to the recovery room.
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