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Need help coding this - Takedown of ileostomy

  1. #1
    Default Need help coding this - Takedown of ileostomy
    Medical Coding Books
    PROCEDURES PERFORMED: Takedown of ileostomy, partial resection of small
    bowel, partial resection of sigmoid colon, and ileorectal anastomosis.

    ANESTHESIA: General anesthesia.

    DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and
    was placed in supine position. General endotracheal anesthesia was induced.
    Then, we closed the ileostomy shut with running 2-0 silk suture. Then, entire
    abdomen and rectal areas were prepped and draped in a sterile fashion. Then,
    we made a midline incision encircling the umbilicus to the left side.
    Subcutaneous tissues were incised and the patient was incised and abdomen was
    entered. There is some adhesions present and these were taken down. Then, we
    looked at the ileostomy from inside and the small bowel looked fine. Proximal
    to the ileostomy. Hence, we made an elliptical incisions on either side of
    the ileostomy on the skin and subcutaneous tissues were incised and we
    dissected the ileostomy all the way down to the fascia and then the patient
    was transected all around. Then, the ileostomy was taken into the abdominal
    cavity. We resected about 6 inches of small bowel using a GIA stapler. Then,
    we went down to the pelvis and found extensive adhesions between the uterus
    and left fallopian tube, and distal sigmoid colon. These were carefully
    dissected. Eventually, we were able to get to the sigmoid colon and this was
    dissected to the hollow of the sacrum. There was few and explains of the
    sigmoid colon, which would be difficult to do the anastomosis. Hence using a
    TIA stapler, we dissected the part of the sigmoid colon. Then, we did
    anastomosis using EEA stapler. We decided to use 29-mm EEA stapler. We
    transected the stapled end of the terminal ileum and placed a purse-string
    suture with 3-0 Prolene suture. Then, the head of the EEA stapler was then
    placed inside and the purse-string suture was tied. Then, the EEA itself was
    brought in from the rectum and we had put the needle through the anterior
    aspect of the rectal segment. Then, the 2 piece of instrument were attached
    and the EEA instrument was tightened and fired. This resulted in good
    anastomosis and we obtained 2 good rings. Then, we inflated air under water
    and there are no leak seen. At this point, we obtained hemostasis and
    proceeded to close the abdomen in layers. The fascia and peritoneum were
    closed in a single layer using 0 Prolene sutures starting at both and then
    were tied in the center. A #2 nylon retention sutures were also applied.
    Subcutaneous tissues were closed with interrupted 3-0 Vicryl sutures. Skin
    was closed with staples. Then, we went into the ostomy site and the fascia
    was closed with running 0 Prolene sutures. Again, subcutaneous tissues were
    closed with interrupted 3-0 Vicryl sutures and skin was loosely approximated
    with staples leaving some gaps here and there open because of the infected
    nature of this wound. Then, sterile dressings were applied and an abdominal
    binder was placed. She was then transferred out of the operating room in a
    stable condition.

  2. #2
    look at 44625,44626

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