Wiki Open right colectomy and cholecystectomy

KBean2018

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Hello, I am not use to coding colectomies, I am reviewing 44140, 44144, 44160. I know that I will code 47600 for the cholecystectomy. Any help on the colectomy will be appreciated. Thanks in advance.

PREOPERATIVE DIAGNOSIS: Advanced polyp ileocecal valve. Cholecystitis/cholelithiasis

PROCEDURE: Open right colectomy and cholecystectomy

SPECIMENS: 1. Right colon (suture at lesion of the ileocecal valve) 2. Gallbladder

An upper midline incision was performed and carried just inferior to the umbilicus. The incision was carried down through the abdominal wall fascia. The abdomen was entered and explored. The liver was normal. The gallbladder was not acutely inflamed. The small bowel was run from the ligament of Treitz to the ileocecal valve and was normal. A mass was nonpalpable within the cecum. The Omni retractor was used for exposure.

The terminal ileum was elevated and a small rent was made in the mesentery allowing for the ileum to be divided with a GIA stapler, about 5 cm from the ileocecal valve. The appendiceal mesentery in the right colon was then mobilized in a routine manner by first dividing the avascular lateral line. The ureter was identified and protected. The mesentery was scored in a V-shaped manner. The right colic artery was palpated. The hepatic flexure was mobilized there were some adhesions to the inferior edge of the right hepatic lobe that were divided. The duodenum was identified and protected. The hepatic flexure was then divided following a small rent in the colonic mesentery, using a GIA stapler. The right colon was then elevated and its mesentery was divided between Kelly clamps and tied off with 0 silk suture. In addition, the right colic artery was suture-ligated with a 2-0 silk ligature.

The right colon was opened on the back table and a broad-based advanced polypoid lesion was noted at the ileocecal valve that was labeled with a silk suture.

Prior to completing the anastomosis, the subhepatic space was exposed and an open cholecystectomy was performed in a routine manner. The gallbladder was elevated with 2 Kelly clamps and the peritoneum overlying the cystic artery and duct was incised. A right angle clamp was used to create a posterior window. Both structures were doubly clipped proximally and singly clipped distally before being divided. The gallbladder was then peeled off the liver in a routine manner. It was sent to pathology. The liver bed was slightly oozy and this was controlled with electrocautery and a singular piece of Surgicel. A dry pack was placed in the area was subsequently inspected following the anastomosis and found to be hemostatic without evidence of bleeding or bile leak. The clips were intact.

Attention was then directed to completing the ileocolic anastomosis. The 2 ends of bowel were lined up and a posterior layer of interrupted 3-0 silk was placed. Enterotomies were created and the GIA-75 and TA 60 devices used to create an anastomosis. The anterior anastomosis was reinforced with interrupted horizontal mattress sutures of 3-0 silk. The transverse staple line was oversewn with a running 3-0 silk. Mesentery was closed with a running 2-0 chromic.

The subhepatic space, suprahepatic space right paracolic gutter and pelvis were then irrigated with 2 L of warm saline. E fluent was clear. There is no bleeding. The anastomosis was without tension and nonischemic. The fascia was then closed using a running looped #1 PDS. The subcu space was irrigated and the skin was closed with staples. An incisional VAC was placed.i
 
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