PREOPERATIVE DIAGNOSIS: Abdominal pain.
POSTOPERATIVE DIAGNOSIS:
1. Abdominal pain.
2. Seroma at the area of the umbilicus.
3. Intraabdominal adhesions.
PROCEDURE PERFORMED:
1. Diagnostic laparoscopy.
2. Lysis of adhesions.
3. Abdominal wall exploration.
4. Excision of seroma cavity.
ANESTHESIA: General endotracheal with approximately 30 mL of 0.5% Marcaine subcutaneously.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None immediate.
SPECIMENS: Portions of seroma cavity, not sent to Pathology.
DISPOSITION: The patient tolerated the procedure well.
PROCEDURE: After informed consent was obtained, the patient was taken to the operating suite and placed in supine position. Next, anesthesia was administered by Anesthesiology and titrated to effect. Next, the abdomen was then shaved using electric clippers. It was then prepped and draped in a sterile fashion. Next, in the supraumbilical area over a previous scar, a curvilinear incision was then made. This was then carried down through the subcutaneous tissue using electrocautery. Once the seroma cavity was visualized, it was dissected free from the surrounding tissue on all sides and excised from the fascial base. Next, the umbilicus was then taken off the fascia taken care not to injure the umbilical skin. Once this was completely taken off the fascia, we then everted the umbilicus. There were no signs of any chronic fistula or drainage from the base of the umbilicus, so then a vertical incision was made through the fascia using electrocautery. Next, the muscle was split using two S retractors. The peritoneum was elevated using 2 hemostats and incised using Metzenbaum scissors and then 2-0 Vicryl stay sutures. We placed one on each side of the fascial opening. The Hasson trocar was then inserted, and the abdomen was insufflated to 16 mmHg. Next, a laparoscope was introduced. We visualized the intraabdominal space. A 5 mm trocar was then inserted in the right abdomen laterally.
We then took down adhesions between the omentum and the underside of the previous umbilical hernia repair. Once the adhesions were lysed, a 360 degree survey of the abdomen was performed. There were no abnormalities noted. Next, all trocars were removed. Air was evacuated the abdomen. The anterior rectus fascia was closed using 0 nylon suture in a figure-of-eight fashion. All port sites were irrigated out and suctioned dry. The umbilical skin was reattached in the left fascia using 3-0 Vicryl suture. Subcutaneous tissue was closed using 3-0 Vicryl suture, and the skin was closed using 4-0 Monocryl suture in a subcuticular fashion. All of the incisions were injected with 30 mL of 0.5% Marcaine split between the incisions. A sterile dressing was then applied. The patient was then extubated and transferred to the recovery room in stable condition.
Would you code the abdominal wall exploration? They are not aspirating the seroma so not quite sure on this one.... ideas would be appreciated.
POSTOPERATIVE DIAGNOSIS:
1. Abdominal pain.
2. Seroma at the area of the umbilicus.
3. Intraabdominal adhesions.
PROCEDURE PERFORMED:
1. Diagnostic laparoscopy.
2. Lysis of adhesions.
3. Abdominal wall exploration.
4. Excision of seroma cavity.
ANESTHESIA: General endotracheal with approximately 30 mL of 0.5% Marcaine subcutaneously.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None immediate.
SPECIMENS: Portions of seroma cavity, not sent to Pathology.
DISPOSITION: The patient tolerated the procedure well.
PROCEDURE: After informed consent was obtained, the patient was taken to the operating suite and placed in supine position. Next, anesthesia was administered by Anesthesiology and titrated to effect. Next, the abdomen was then shaved using electric clippers. It was then prepped and draped in a sterile fashion. Next, in the supraumbilical area over a previous scar, a curvilinear incision was then made. This was then carried down through the subcutaneous tissue using electrocautery. Once the seroma cavity was visualized, it was dissected free from the surrounding tissue on all sides and excised from the fascial base. Next, the umbilicus was then taken off the fascia taken care not to injure the umbilical skin. Once this was completely taken off the fascia, we then everted the umbilicus. There were no signs of any chronic fistula or drainage from the base of the umbilicus, so then a vertical incision was made through the fascia using electrocautery. Next, the muscle was split using two S retractors. The peritoneum was elevated using 2 hemostats and incised using Metzenbaum scissors and then 2-0 Vicryl stay sutures. We placed one on each side of the fascial opening. The Hasson trocar was then inserted, and the abdomen was insufflated to 16 mmHg. Next, a laparoscope was introduced. We visualized the intraabdominal space. A 5 mm trocar was then inserted in the right abdomen laterally.
We then took down adhesions between the omentum and the underside of the previous umbilical hernia repair. Once the adhesions were lysed, a 360 degree survey of the abdomen was performed. There were no abnormalities noted. Next, all trocars were removed. Air was evacuated the abdomen. The anterior rectus fascia was closed using 0 nylon suture in a figure-of-eight fashion. All port sites were irrigated out and suctioned dry. The umbilical skin was reattached in the left fascia using 3-0 Vicryl suture. Subcutaneous tissue was closed using 3-0 Vicryl suture, and the skin was closed using 4-0 Monocryl suture in a subcuticular fashion. All of the incisions were injected with 30 mL of 0.5% Marcaine split between the incisions. A sterile dressing was then applied. The patient was then extubated and transferred to the recovery room in stable condition.
Would you code the abdominal wall exploration? They are not aspirating the seroma so not quite sure on this one.... ideas would be appreciated.