Takedown aortoenteric fistula

daniel

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Hello All.
How do you see this?
CPT 37779 benchmark to 35870 Repair of graft-enteric fistula
or
CPT 49999 benchmark to Omental flap, intra-abdominal (List separately in addition to code for primary procedure)



OP Note
Takedown aortoenteric fistula


INDICATION FOR SURGery: Elected to takedown of the enteric side of the fistula with interposition omental patch to attempt to prevent infection of the aortic graft.



OPERATIVE PROCEDURE IN DETAIL: X was prepped & draped in usual sterile fashion. The abdomen was entered and LOA until the area of the proximal anastomosis. I proceeded with caution to peel the duodenum away from the aorta. I visualized prolene suture and eventually identified it as the proximal anastomosis of the patient's prior aortic aneurysm repair. There was violation of the duodenum at this area,. Because there appeared to be no bile staining, no inflammatory mass surrounding the rest of the graft and no obvious infection, we opted to leave the graft in situ and instead position an omental patch across the graft in the retroperitoneum. Duodenum repaired primarily and drain left over the omentum
 
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