cooper1
Guru
I need help coding the following op report exploratory lap and drainage with vacuum pack open abdominal draina dn jp drains in the lesser sac root of the mesentery and left gutter.
"incision was made from xiphoid down to the umbilicus and just below. The bovie cautery was then used to dissect down to the level of the fascia and into the peritoneal cavity. The peritoneal cavity was open and bilious drainage was seen. the fluid was aspirated from the bell . the lesser sac was opened just below the level of the stomach with a ligasure device below the level of the gastroepiploic artery. this was opened to see the pancreas. the pancreas was inflamed and edematous and the pancreas was lifted off of the retroperitoneum at which point a draining sinus was seen in the posterior aspect of the pancreas draining biliary fluid.The abdominal cavity was drained with 3 drains one in the lesser sac at the pancreatic distal disruption and one at the root of the mesentery under the transverse mesocolon and one in the left gutter. these were placed to bulb suction. abdomen was closed with a vacuum pack. an ng tube was placed over the kerlix and a towel was placed over the ng tube. the loban was then placed over the entirety of the drape and placed to wall suction through the ng tube."
"incision was made from xiphoid down to the umbilicus and just below. The bovie cautery was then used to dissect down to the level of the fascia and into the peritoneal cavity. The peritoneal cavity was open and bilious drainage was seen. the fluid was aspirated from the bell . the lesser sac was opened just below the level of the stomach with a ligasure device below the level of the gastroepiploic artery. this was opened to see the pancreas. the pancreas was inflamed and edematous and the pancreas was lifted off of the retroperitoneum at which point a draining sinus was seen in the posterior aspect of the pancreas draining biliary fluid.The abdominal cavity was drained with 3 drains one in the lesser sac at the pancreatic distal disruption and one at the root of the mesentery under the transverse mesocolon and one in the left gutter. these were placed to bulb suction. abdomen was closed with a vacuum pack. an ng tube was placed over the kerlix and a towel was placed over the ng tube. the loban was then placed over the entirety of the drape and placed to wall suction through the ng tube."