tadailey
Contributor
One of my physician's performed an ileovesicostomy surgery on a quadriplegic patient with neurogenic bladder. I was looking at the continent diversion code 50825 but the more I think about this I'm just not sure this is the correct code. OP note states below:
A midline incision was made from the umbilicus to the pubic symphysis. This was taken down to the deeper structures, I opened the rectus fashion the midline, and split the bellies of rectus fascia. This gave me good access to the patient's space of Retzius which was developed bluntly selective free of the bladder.
I then opened the peritoneum, identified the ileocecal valve and identified a segment of ileum 15 cm away from the ileocecal valve to use as the ileal chimney. The proximal and distal segments of the chimney were tagged with silk suture. Identified the vascular arcades through the patient's somewhat thickened mesentery. I then localized the ileal segment to be used as the ileal chimney. GIA 55 stapler device in the standard fashion I isolated the segment to be used as the chimney. Anastomosis was created with the GIA 55 stapler as well. The ends were3 imbricated with silk sutures placed in a Lembert style. I then spatulated this approximately 5-6 cm at the proximal segment at the intermesenteric border.
The bladder was partial distented and I tagged areas in the bladder with sild suture and created a cystotomy in an inverted U-shaped fashion on a wide-based pedicle. This was taken full-thickness into the bladder lumen. I then used a 2-0 silk suture to tag the corners of the non-spatulated segment of the ureter to the base of the bladder flap. I then used a total of 3 running sutures to anastomose the ileum to the bladder. The ileal chimney distal segment was brought up to the patient's left lower quadrant ostomy site that had been created. Sharp dissection was used to remove the skin with dissection taken down to the rectus fascia. Cruciate incision was made, 2-0 Vicryl suture placed at the cruciate segments and then this was used to tag the leal chimney mucosa with care not to injure the mesentery or basket or supply. Stoma was matured.
Any help is greatly appreciated.
Teresa D
A midline incision was made from the umbilicus to the pubic symphysis. This was taken down to the deeper structures, I opened the rectus fashion the midline, and split the bellies of rectus fascia. This gave me good access to the patient's space of Retzius which was developed bluntly selective free of the bladder.
I then opened the peritoneum, identified the ileocecal valve and identified a segment of ileum 15 cm away from the ileocecal valve to use as the ileal chimney. The proximal and distal segments of the chimney were tagged with silk suture. Identified the vascular arcades through the patient's somewhat thickened mesentery. I then localized the ileal segment to be used as the ileal chimney. GIA 55 stapler device in the standard fashion I isolated the segment to be used as the chimney. Anastomosis was created with the GIA 55 stapler as well. The ends were3 imbricated with silk sutures placed in a Lembert style. I then spatulated this approximately 5-6 cm at the proximal segment at the intermesenteric border.
The bladder was partial distented and I tagged areas in the bladder with sild suture and created a cystotomy in an inverted U-shaped fashion on a wide-based pedicle. This was taken full-thickness into the bladder lumen. I then used a 2-0 silk suture to tag the corners of the non-spatulated segment of the ureter to the base of the bladder flap. I then used a total of 3 running sutures to anastomose the ileum to the bladder. The ileal chimney distal segment was brought up to the patient's left lower quadrant ostomy site that had been created. Sharp dissection was used to remove the skin with dissection taken down to the rectus fascia. Cruciate incision was made, 2-0 Vicryl suture placed at the cruciate segments and then this was used to tag the leal chimney mucosa with care not to injure the mesentery or basket or supply. Stoma was matured.
Any help is greatly appreciated.
Teresa D