Can somone help with this? I looked at 47900 but Im not sure what it means by pre-existing injury, this patient was returned to OR for bile leak.
Written informed consent was obtained from the patient, sites were marked, and she was taken from the preoperative staging area to the operating room suite, placed supine on the operating room table. General endotracheal anesthesia was introduced. Antibiotics were infused. Abdomen was prepped and draped in normal sterile fashion. Staples removed. Fascial sutures were cut and then removed. The fascia was then opened and we carefully explored the abdomen. Self-retaining Bookwalter retractor was placed and the liver was retracted exposing the biliary anastomosis. Anteriorly was fairly clean. Posteriorly, there was bile staining and controlled by the adjacent drain. The drain was retracted and we gently irrigated with saline and examined the anastomosis. There appeared to be a pinpoint area of biliary leakage around some posterior sutures. I opened the duodenum and placed a blood tunneler through the duodenum, through the biliary anastomosis, through the right hepatic radical, and then out the dome of the liver substance. This was then used to pull a pigtailed PTC catheter with the pigtail portion positioned in the duodenum. The catheter was then brought through the abdominal wall and secured to the skin in the right upper quadrant with suture. The catheter was flushed ensuring good function and good position. I then closed the insertion site on the duodenum with 3-0 PDS sutures. The posterior aspect of the hepatobiliary was also reinforced with interrupted 5-0 PDS sutures controlling the biliary leak quite well. We irrigated with warm saline. I placed the biliary drain back in its position in the subhepatic space. I then took down the retractors and closed the fascia with #1 looped PDS suture starting superiorly and inferiorly and tied in the center. I irrigated the subcutaneous tissues thoroughly and then closed the midline incision with staples, wicked intermittently with gauze. I then dressed with Airstrip dressing. Drain exit sites were dressed with antibiotic impregnated Bioclusive dressings. All lap, sponge, instrument, and needle counts correct prior to completion of case. The patient was awoken from anesthesia and taken to recovery room in stable condition.
Written informed consent was obtained from the patient, sites were marked, and she was taken from the preoperative staging area to the operating room suite, placed supine on the operating room table. General endotracheal anesthesia was introduced. Antibiotics were infused. Abdomen was prepped and draped in normal sterile fashion. Staples removed. Fascial sutures were cut and then removed. The fascia was then opened and we carefully explored the abdomen. Self-retaining Bookwalter retractor was placed and the liver was retracted exposing the biliary anastomosis. Anteriorly was fairly clean. Posteriorly, there was bile staining and controlled by the adjacent drain. The drain was retracted and we gently irrigated with saline and examined the anastomosis. There appeared to be a pinpoint area of biliary leakage around some posterior sutures. I opened the duodenum and placed a blood tunneler through the duodenum, through the biliary anastomosis, through the right hepatic radical, and then out the dome of the liver substance. This was then used to pull a pigtailed PTC catheter with the pigtail portion positioned in the duodenum. The catheter was then brought through the abdominal wall and secured to the skin in the right upper quadrant with suture. The catheter was flushed ensuring good function and good position. I then closed the insertion site on the duodenum with 3-0 PDS sutures. The posterior aspect of the hepatobiliary was also reinforced with interrupted 5-0 PDS sutures controlling the biliary leak quite well. We irrigated with warm saline. I placed the biliary drain back in its position in the subhepatic space. I then took down the retractors and closed the fascia with #1 looped PDS suture starting superiorly and inferiorly and tied in the center. I irrigated the subcutaneous tissues thoroughly and then closed the midline incision with staples, wicked intermittently with gauze. I then dressed with Airstrip dressing. Drain exit sites were dressed with antibiotic impregnated Bioclusive dressings. All lap, sponge, instrument, and needle counts correct prior to completion of case. The patient was awoken from anesthesia and taken to recovery room in stable condition.