Wiki Lap appedndectomy, partial cecectomy and closure of enterotomy?

jdibble

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Any suggestions on how this should be coded? I am not sure if I should be coding the appy with an unlisted code for the other procedures, just the appy or something else!

Help! :confused:

PREOPERATIVE DIAGNOSIS: Acute appendicitis.

POSTOPERATIVE DIAGNOSIS: Acute and chronic appendicitis.

OPERATION: Laparoscopic appendectomy, partial cecectomy and closure of
enterotomy.

DRAINS: Foley catheter and orogastric tube removed postoperatively and large
round Jackson-Pratt drain to right lower extremity.

COMPLICATIONS: None.

FINDINGS: A very thickened appendicitis that appeared to be more chronic than
acute, although the patient only complained of 5 days of abdominal pain. There
were also enlarged lymph nodes that made this appear quite suspicious. The
remainder of the laparoscopy appeared within normal limits, but in order to
actually remove all of the inflammation the cecal cap was removed.

DESCRIPTION OF PROCEDURE: The patient was taken emergently to the operating
room and, after the induction of satisfactory general endotracheal anesthesia,
was prepped and draped in the usual sterile fashion in the supine position. A
Veress needle was placed at the umbilicus and, after a positive drip test, first
low and then high-flow pneumoperitoneum was attained equally distending the
abdomen. A 5 mm optical trocar was placed in the left lower quadrant. A 5 mm
trocar was placed under direct visualization at the umbilicus. Exploratory
laparoscopy revealed the above and, at this point, a 12 mm trocar was placed in
the suprapubic area. The appendix was somewhat retrocecal and after mobilizing
the cecum a very thickened appendix was elevated. The cecum was then incised
from its lateral attachments and brought medially and ventrally. The appendix
was quite large and thick-walled and the inflammation went down to the level of
the cecal cap. This was somewhat suspicious for tumor including a very large
lymph node that was identified and taken with the specimen. The blood supply to
the appendix was taken using the harmonic scalpel and the appendix elevated and
divided using a 60 mm Echelon stapler, removing the cecal cap. This was placed
into a bag and removed through the 12 mm port. It was difficult to clearly
elucidate if the ileocecal valve was completely intact and an enterotomy was
created in the ileum just proximal to the ileocecal valve and this was explored
and found to be intact. The enterotomy was then closed using 2 layers with a
continuous 3-0 Vicryl running full thickness suture and an interrupted 3-0 silk
Lembert-type suture for a second layer of closure. The abdomen was copiously
irrigated and aspirated and an additional 5 mm port was placed in the right
middle quadrant to advance a large round Jackson-Pratt drain into the right
lower quadrant and pelvis. After removing the port, this was secured with a
silk suture. The abdomen was desufflated and the 12 mm port site closed with an
0 Maxon suture. Subcutaneous tissues and skin were closed with 3-0 Vicryl
sutures. Steri-strips and sterile bandages were applied. The patient tolerated
the procedure satisfactorily and returned to recovery in stable condition. All
final sponge, instrument and needle counts correct.

Thanks!
 
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