Wiki hiatal hernia repair with small bowel resection of afferent Roux limb

Diana29

New
Messages
7
Location
Greenwood, IN
Best answers
0
Can someone help me with a CPT code for this?





DESCRIPTION OF PROCEDURE:  The patient was brought to the operative
suite, placed supine, induced under satisfactory general anesthetic
without complication.  Thromboguards and IV antibiotics were used
prophylactically.  The abdomen was prepped and draped in standard
fashion.  We entered a 1 cm umbilical incision, insufflating with a
Veress needle 15 mmHg.  The left upper quadrant was then entered with
5 mm optical trocar and laparoscope safely entering through the
layers of the abdominal wall with no injury.  All subsequent ports
were also placed under direct visualization.  The liver was elevated
with a Nathanson retractor.  We noted adhesions of the Roux limb
folded upon itself and also besides this efferent portion of the
limb.  The  afferent limb was redundant and folded upon itself.  We
asked Dr. Good to try to place an orogastric tube or easy tube and it
would not pass through the hiatus with ease.  Once it did, it kept
getting stuck in the afferent Roux limb.  We then undertook an
extensive lysis of adhesions of the gastric pouch finding that she
did indeed have a large patulous hiatal hernia and once we freed that
up, the dilator was able to pass into the gastric pouch, but still
repeatedly got caught in the afferent limb.  Therefore, with a 36
dilator in place, we repaired the hiatus posteriorly, suturing the
crura with a running 0 Dacron suture and placing a single stitch
anteriorly as well.  Then, we resected the afferent Roux limb
redundant portions so that the dilator would have a straight shot
into the efferent Roux limb.  We did this with the dilator in place,
firing a gray cartridge across the mesentery and a blue reinforced
the cartridge across the afferent Roux limb.  We then repeatedly
brought the dilator up into the esophagus and back into the efferent
Roux limb without difficulty whatsoever, having resolved the problem.
 We tested insufflating air under saline and no bubbling returned and
hemostasis was excellent.  We evacuated CO2 from the abdomen after
removing the specimen.  Note should be made that we did check the
mesenteric spaces upon entry and there was no sign of internal hernia
or other distal adhesions.  After evacuation of the CO2, the
umbilical fascia was closed with 0 Vicryl and skin with 3-0 Monocryl.
 Tissue sealant was applied followed by an abdominal binder.  The
patient tolerated the procedure without intraoperative complications.
 Sponge, needle and instrument counts were correct at the end of
procedure.  Blood loss was around 30 mL.  The patient was awakened,
extubated and taken to the recovery area in satisfactory condition.
 
Top