PREOPERATIVE DIAGNOSIS: Long blind limb.
POSTOPERATIVE DIAGNOSIS: Long blind limb.
PROCEDURE PERFORMED:
1. Diagnostic laparoscopy.
2. Small bowel resection.
ANESTHESIA: General endotracheal with approximately 30 mL of 0.5% Marcaine subcutaneously.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: No immediate.
SPECIMENS: Portions of small bowel.
DISPOSITION: The patient tolerated the procedure well.
PROCEDURE: After informed consent was obtained, the patient was taken to the operating suite and placed in supine position. Next, anesthesia was administered by Anesthesiology and titrated to effect. Next, the abdomen was then prepped and draped in sterile fashion.
Next, using an 11-blade scalpel, a supraumbilical incision was made vertically. This was then carried down through the subcutaneous tissues using electrocautery. Once the anterior rectus fascia was visualized, a vertical incision was made using electrocautery. Next, two 0 Vicryl stay sutures were placed, one on each of side of the vertical incision. Next, the muscle was split using 2 S retractors. The peritoneum was elevated using 2 hemostats and incised using Metzenbaum scissors. Next, a finger sweep was performed. There were no adhesions noted. Next, a Hasson trocar was then inserted, and the abdomen was insufflated to 186 mmHg. Next, the laparoscope was introduced. We visualized the intraabdominal space. There were some adhesions noted between the omentum and the anterior abdominal wall. The patient was then placed in steep reverse Trendelenburg position, and then four 4 mm trocars were then inserted. Next, using the Harmonic scalpel, we then dissected down adhesions between the omentum and the anterior abdominal wall. Next, the liver retractor was then inserted, elevated the left lobe of the liver superiorly and laterally. We dissected down adhesions between the left lobe of the liver and the stomach before it could be completely elevated out of the way. Next, we identified the long blind limb. It was approximately 7 cm and, with the history of patient's reflux and food getting stuck in the blind limb, it was decided to resect the blind limb. We dissected down adhesions laterally freeing up the small bowel and the blind limb. Then the mesentery of the blind limb was then taken using the Harmonic scalpel. Then the blind limb was then stapled off using laparoscopic Endo-GIA stapler, tan cartridge. A portion of the small bowel was placed in an EndoCatch bag, removed from the supraumbilical port site, and placed on the back table. The laparoscope was then reintroduced. We visualized the intraabdominal space. The staple line showed no signs of any bleeding or leakage. A 360 degree survey of the abdomen was performed. There were no other abnormalities noted.
Next, all trocars were removed, and the laparoscope and Hasson trocar were removed. Air was evacuated from the abdomen. The anterior rectus fascia of the periumbilical port site was closed using 0 Vicryl suture in a figure-of-8 fashion. All port sites were irrigated out and suctioned dry, and the skin incisions were closed using 4-0 Monocryl suture in a subcuticular fashion. All the incisions were injected with 30 mL of 0.5% Marcaine split between the incisions, and a sterile dressing was then applied. The patient was then extubated and transferred to the recovery room in stable condition.
Looking for CPT code and dx code please.....
POSTOPERATIVE DIAGNOSIS: Long blind limb.
PROCEDURE PERFORMED:
1. Diagnostic laparoscopy.
2. Small bowel resection.
ANESTHESIA: General endotracheal with approximately 30 mL of 0.5% Marcaine subcutaneously.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: No immediate.
SPECIMENS: Portions of small bowel.
DISPOSITION: The patient tolerated the procedure well.
PROCEDURE: After informed consent was obtained, the patient was taken to the operating suite and placed in supine position. Next, anesthesia was administered by Anesthesiology and titrated to effect. Next, the abdomen was then prepped and draped in sterile fashion.
Next, using an 11-blade scalpel, a supraumbilical incision was made vertically. This was then carried down through the subcutaneous tissues using electrocautery. Once the anterior rectus fascia was visualized, a vertical incision was made using electrocautery. Next, two 0 Vicryl stay sutures were placed, one on each of side of the vertical incision. Next, the muscle was split using 2 S retractors. The peritoneum was elevated using 2 hemostats and incised using Metzenbaum scissors. Next, a finger sweep was performed. There were no adhesions noted. Next, a Hasson trocar was then inserted, and the abdomen was insufflated to 186 mmHg. Next, the laparoscope was introduced. We visualized the intraabdominal space. There were some adhesions noted between the omentum and the anterior abdominal wall. The patient was then placed in steep reverse Trendelenburg position, and then four 4 mm trocars were then inserted. Next, using the Harmonic scalpel, we then dissected down adhesions between the omentum and the anterior abdominal wall. Next, the liver retractor was then inserted, elevated the left lobe of the liver superiorly and laterally. We dissected down adhesions between the left lobe of the liver and the stomach before it could be completely elevated out of the way. Next, we identified the long blind limb. It was approximately 7 cm and, with the history of patient's reflux and food getting stuck in the blind limb, it was decided to resect the blind limb. We dissected down adhesions laterally freeing up the small bowel and the blind limb. Then the mesentery of the blind limb was then taken using the Harmonic scalpel. Then the blind limb was then stapled off using laparoscopic Endo-GIA stapler, tan cartridge. A portion of the small bowel was placed in an EndoCatch bag, removed from the supraumbilical port site, and placed on the back table. The laparoscope was then reintroduced. We visualized the intraabdominal space. The staple line showed no signs of any bleeding or leakage. A 360 degree survey of the abdomen was performed. There were no other abnormalities noted.
Next, all trocars were removed, and the laparoscope and Hasson trocar were removed. Air was evacuated from the abdomen. The anterior rectus fascia of the periumbilical port site was closed using 0 Vicryl suture in a figure-of-8 fashion. All port sites were irrigated out and suctioned dry, and the skin incisions were closed using 4-0 Monocryl suture in a subcuticular fashion. All the incisions were injected with 30 mL of 0.5% Marcaine split between the incisions, and a sterile dressing was then applied. The patient was then extubated and transferred to the recovery room in stable condition.
Looking for CPT code and dx code please.....