krista2178@yahoo.com
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Need help, MD is stating procedure performed is a Colpocleisis (Complete vaginectomy) and Levator plication with perineorrhaphy. Auditor is saying this was a combined anteroposterior colporrhaphy. What is this and what CPTs to use?
FINDINGS:
Massive complete vaginal vault prolapse of 9cm of vaginal length which was primarily enterocele and cystocele.
On cystoscopy, bilateral effluxing ureteral orifices were visualized and no foreign bodies, lesions or stones seen on full bladder survey at the conclusion of the case.
PROCEDURE DESCRIPTION:
After patient was counseled and consent was reviewed, she was brought into the operating room. Once adequate anesthesia was obtained, the patient was positioned in dorsal high lithotomy position using Allen stirrups and arms were padded and out to the side in a neurologically neutral position. The sequential compression devices were in place on the legs. She was prepped and draped in the normal sterile fashion. The foley was placed to gravity. Time out was performed.
Attention was then drawn to the vagina where two allis clamps were placed to define the vaginal apex. 0.25% marcaine with epinephrine was then injected under the entire vaginal epithelium, creating a hydrodissection. The vaginal mucosa quadrants were marked with the Bovie. A vertical incision was made with a scalpel in the anterior vaginal wall mucosa. Using Metzenbaum scissors and allis clamps for retraction, the underlying fascia of the anterior and posterior vaginal walls and enterocele were dissected off full-thickness vaginal epithelium. Excess vaginal epithelium was trimmed. Using 0-Vicryl the vagina was reduced using a series of interrupted imbricating sutures. Once the enterocele, rectocele and cystocele were completely imbricated and meeting the perineum equally, a levator plication and tight perineorrhaphy was performed using interrupted 0-Vicryl sutures to narrow the vaginal introitus and build up the perineal body. This was done with a gloved finger in the rectum to ensure no rectal injury given its proximity. The vaginal epithelium was then closed using interrupted 2-0 Vicryl, with excellent hemostasis noted.
FINDINGS:
Massive complete vaginal vault prolapse of 9cm of vaginal length which was primarily enterocele and cystocele.
On cystoscopy, bilateral effluxing ureteral orifices were visualized and no foreign bodies, lesions or stones seen on full bladder survey at the conclusion of the case.
PROCEDURE DESCRIPTION:
After patient was counseled and consent was reviewed, she was brought into the operating room. Once adequate anesthesia was obtained, the patient was positioned in dorsal high lithotomy position using Allen stirrups and arms were padded and out to the side in a neurologically neutral position. The sequential compression devices were in place on the legs. She was prepped and draped in the normal sterile fashion. The foley was placed to gravity. Time out was performed.
Attention was then drawn to the vagina where two allis clamps were placed to define the vaginal apex. 0.25% marcaine with epinephrine was then injected under the entire vaginal epithelium, creating a hydrodissection. The vaginal mucosa quadrants were marked with the Bovie. A vertical incision was made with a scalpel in the anterior vaginal wall mucosa. Using Metzenbaum scissors and allis clamps for retraction, the underlying fascia of the anterior and posterior vaginal walls and enterocele were dissected off full-thickness vaginal epithelium. Excess vaginal epithelium was trimmed. Using 0-Vicryl the vagina was reduced using a series of interrupted imbricating sutures. Once the enterocele, rectocele and cystocele were completely imbricated and meeting the perineum equally, a levator plication and tight perineorrhaphy was performed using interrupted 0-Vicryl sutures to narrow the vaginal introitus and build up the perineal body. This was done with a gloved finger in the rectum to ensure no rectal injury given its proximity. The vaginal epithelium was then closed using interrupted 2-0 Vicryl, with excellent hemostasis noted.