mfournier
Networker
Hello Everyone:
Was wondering if someone can review the following op note
Should this be more then 49650? Maybe additional code 15734?
Preoperative diagnosis: Left inguinal hernia
Postoperative diagnosis: Same
Procedure: Laparoscopic left inguinal hernia repair with implantation of mesh
Procedure:
Findings:
Technique: Transabdominal preperitoneal (TAPP)
Hernia Location: Left
Mesh Size &Type: Bard 3D max extra-large
Mesh Fixation: Protek
Description of Procedure:
The patient was brought to the operating room and positioned supine on the table with both arms tucked. Anesthesia was induced without issue. SCDs were placed and the abdomen was prepped and draped in standard fashion. Appropriate prophylactic antibiotics were administered if indicated. A time out was performed.
The abdomen was entered utilizing the umbilical stalk technique. A blunt 5 mm trocar was inserted and the abdomen was insufflated under direct visualization. Additional 5 mm trocars were placed in the left and right abdomen. The initial access trocar was switched to a 12 mm trocar.
There was an indirect left inguinal hernia with bowel contents, as well as cord lipoma on the left side. Utilizing a transabdominal pre peritoneal technique (TAPP), a horizontal incision was made in the peritoneum, immediately below the umbilicus. Dissection was carried out in the pre peritoneal space down to the level of the hernia sac which was reduced into the peritoneal cavity. The cord contents were parietalized and preserved. A large pre peritoneal dissection was created to uncover the direct, indirect, femoral and obturator spaces. Cooper´s ligament was uncovered medially and the psoas muscle uncovered laterally.
A piece of Bard 3d Max extra large left mesh. The mesh was advanced into the pre peritoneal position so that it more than adequately covered the indirect, direct, femoral and obturator spaces. The mesh laid flat, with no inferior folds and covered the entire myopectineal orifice. The mesh was fixated with the Protek to Cooper´s ligament, the posterior aspect of the rectus muscle, and laterally, above the iliopubic tract. The peritoneal flap was closed with the same device. There were no peritoneal defects or exposed mesh at the conclusion.
A transversus abdominis plane (TAP) block was performed bilaterally with a 60 mL mixture containing 0.9% saline, 0.5 % ropivacaine, and 5 mg Dexamethasone. The anesthetic (30 mL) was first injected into the plane between the transversus abdominis and internal abdominal oblique muscles on the left. The TAP was repeated on the contralateral side with 30 mL of the mixture.
The umbilical trocar was removed and the fascial defect was closed with a figure of eight 0 Vicryl suture, utilizing a suture passer. The peritoneal cavity was completely desufflated, the trocars removed and the skin closed with 4-0 Monocryl subcuticular suture and skin glue.
All counts were correct at the end of the procedure. The patient tolerated the procedure well. They were extubated successfully and transferred to the postoperative unit in good condition. Their family was updated as requested
Thank you for any input
Was wondering if someone can review the following op note
Should this be more then 49650? Maybe additional code 15734?
Preoperative diagnosis: Left inguinal hernia
Postoperative diagnosis: Same
Procedure: Laparoscopic left inguinal hernia repair with implantation of mesh
Procedure:
Findings:
Technique: Transabdominal preperitoneal (TAPP)
Hernia Location: Left
Mesh Size &Type: Bard 3D max extra-large
Mesh Fixation: Protek
Description of Procedure:
The patient was brought to the operating room and positioned supine on the table with both arms tucked. Anesthesia was induced without issue. SCDs were placed and the abdomen was prepped and draped in standard fashion. Appropriate prophylactic antibiotics were administered if indicated. A time out was performed.
The abdomen was entered utilizing the umbilical stalk technique. A blunt 5 mm trocar was inserted and the abdomen was insufflated under direct visualization. Additional 5 mm trocars were placed in the left and right abdomen. The initial access trocar was switched to a 12 mm trocar.
There was an indirect left inguinal hernia with bowel contents, as well as cord lipoma on the left side. Utilizing a transabdominal pre peritoneal technique (TAPP), a horizontal incision was made in the peritoneum, immediately below the umbilicus. Dissection was carried out in the pre peritoneal space down to the level of the hernia sac which was reduced into the peritoneal cavity. The cord contents were parietalized and preserved. A large pre peritoneal dissection was created to uncover the direct, indirect, femoral and obturator spaces. Cooper´s ligament was uncovered medially and the psoas muscle uncovered laterally.
A piece of Bard 3d Max extra large left mesh. The mesh was advanced into the pre peritoneal position so that it more than adequately covered the indirect, direct, femoral and obturator spaces. The mesh laid flat, with no inferior folds and covered the entire myopectineal orifice. The mesh was fixated with the Protek to Cooper´s ligament, the posterior aspect of the rectus muscle, and laterally, above the iliopubic tract. The peritoneal flap was closed with the same device. There were no peritoneal defects or exposed mesh at the conclusion.
A transversus abdominis plane (TAP) block was performed bilaterally with a 60 mL mixture containing 0.9% saline, 0.5 % ropivacaine, and 5 mg Dexamethasone. The anesthetic (30 mL) was first injected into the plane between the transversus abdominis and internal abdominal oblique muscles on the left. The TAP was repeated on the contralateral side with 30 mL of the mixture.
The umbilical trocar was removed and the fascial defect was closed with a figure of eight 0 Vicryl suture, utilizing a suture passer. The peritoneal cavity was completely desufflated, the trocars removed and the skin closed with 4-0 Monocryl subcuticular suture and skin glue.
All counts were correct at the end of the procedure. The patient tolerated the procedure well. They were extubated successfully and transferred to the postoperative unit in good condition. Their family was updated as requested
Thank you for any input