clwilliamson
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I'm looking for help with this operative note. Would I use 44143? And is the bladder fistula repair included or coded separately? Thanks!
Abdomen was then prepped and draped in a standard surgical fashion. Lower midline incision was made. Abdomen wasopened and explored. Omni retractor was used. The sigmoid colon was densely stuck to the bladder itself as well as loops of small bowel. This was all carefully taken down. The fistula connection was found and this was bisected. The hole was about the size of a dime. The small bowel was mobilized off of the sigmoid. Once the sigmoid was mobilized, the white line of Toldt was taken down. The ureters were identified. Points of resection proximally and distally were chosen at the sacral promontory and in the descending colon. The sigmoid was divided with Endo-GIA stapling device. Mesentery was severely retracted. This was carefully ligated with Harmonic scalpel and metal clips. The sigmoid was removed en bloc and sent to pathology as a permanent. The distal stump was secured to the anterior abdominal wall with a 2-0 Prolene. There was dense inflammation in the pelvis. The edges of the bladder were cleaned up with sharp dissection and then the bladder defect was repaired in 2 layers with interrupted 3-0 Vicryl suture. A site was chosen in the left lower quadrant. The descending colon was brought out through this. The colostomy was under no tension, nor was it kinked. The rest of the abdomen was explored. No other abnormalities were noted. Small bowel was examined where it was stuck to the sigmoid area. There were some superficial rents. These were oversewn with 3-0 Vicryl suture. The abdomen was irrigated, explored. No other abnormalities were noted. Blood loss was minimal. JP drain was placed in the pelvis and brought out through the right lower quadrant. All instruments, sponges were counted 3 times. The abdomen was then closed with looped PDS suture and skin staples. The lower part of the wound was weft with 1-inch iodoform gauze. The colostomy was then matured with 3-0 Vicryl suture. The colostomy was pink, viable and looking healthy at the end of the case. It was digitalized. There was no tension on it or difficulty getting to the fascia.
Abdomen was then prepped and draped in a standard surgical fashion. Lower midline incision was made. Abdomen wasopened and explored. Omni retractor was used. The sigmoid colon was densely stuck to the bladder itself as well as loops of small bowel. This was all carefully taken down. The fistula connection was found and this was bisected. The hole was about the size of a dime. The small bowel was mobilized off of the sigmoid. Once the sigmoid was mobilized, the white line of Toldt was taken down. The ureters were identified. Points of resection proximally and distally were chosen at the sacral promontory and in the descending colon. The sigmoid was divided with Endo-GIA stapling device. Mesentery was severely retracted. This was carefully ligated with Harmonic scalpel and metal clips. The sigmoid was removed en bloc and sent to pathology as a permanent. The distal stump was secured to the anterior abdominal wall with a 2-0 Prolene. There was dense inflammation in the pelvis. The edges of the bladder were cleaned up with sharp dissection and then the bladder defect was repaired in 2 layers with interrupted 3-0 Vicryl suture. A site was chosen in the left lower quadrant. The descending colon was brought out through this. The colostomy was under no tension, nor was it kinked. The rest of the abdomen was explored. No other abnormalities were noted. Small bowel was examined where it was stuck to the sigmoid area. There were some superficial rents. These were oversewn with 3-0 Vicryl suture. The abdomen was irrigated, explored. No other abnormalities were noted. Blood loss was minimal. JP drain was placed in the pelvis and brought out through the right lower quadrant. All instruments, sponges were counted 3 times. The abdomen was then closed with looped PDS suture and skin staples. The lower part of the wound was weft with 1-inch iodoform gauze. The colostomy was then matured with 3-0 Vicryl suture. The colostomy was pink, viable and looking healthy at the end of the case. It was digitalized. There was no tension on it or difficulty getting to the fascia.