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Colpocleisis with McCall culdoplasty

  1. #1
    Default Colpocleisis with McCall culdoplasty
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    I was not sure if you can bill both together. I got 57120 and 57283?

    PREOPERATIVE DIAGNOSIS: Vaginal vault prolapse, enterocele attenuation of the perineal body and vaginal wall erosion secondary to prolapse.

    POSTOPERATIVE DIAGNOSIS: Vaginal vault prolapse, enterocele attenuation of the perineal body and vaginal wall erosion secondary to prolapse, capacious enterocele.

    PROCEDURES PERFORMED: Colpocleisis, McCall culdoplasty, enterocele repair, perineorrhaphy and cystourethroscopy.

    FINDINGS: Erosion of the vaginal wall secondary to eversion, complete vaginal vault prolapse, capacious enterocele, small bowel within enterocele sac in the vagina, normal cystourethroscopy with patent ureteral orifices bilaterally.

    DESCRIPTION OF PROCEDURE: The patient was brought into the operating room, placed seated on the operating room table where spinal anesthesia was administered in the usual fashion. she as then placed in the dorsal lithotomy position, prepped and draped in the usual fashion for vaginal surgery. A Lone Star retractor was used to retract the vaginal interoitus.

    A transurethral Foley was placed. Marcaine 0.25% with Epinephrine and without was diluted half and half and infiltrated into the perineal body and vaginal mucosa. Essentially, an incision into the vaginal wall was performed just beneath the urethral meatus for the length of the vaginal mass to the perineal body hymenal ring. The vesicovaginal fascia was reflected by blunt and sharp dissection using cautery and 4 x 4. A large capacious enterocele was encountered within this vaginal mass protruding through the vaginal introitus, containing multiple loops of small bowel. Initially, I tried a baby lap, but eventually I needed a large lap to insert into the abdomen to displace the small bowel out of the vagina. i dissected the enterocele sac away from the vaginal walls. Because of capacious nature of the enterocele, I elected to place a series of 2-0 silk suture laterally from side-to-side posteriorly as McCall culdoplasty to obliterate the posterior aspect of the cul-de-sac. This essentially plicated the remnants of the uterosacral ligaments. I then closed off the enterocele sac with interrupted 0 Vicryl sutures. Copious excess vaginal tissue was excised. The vagina was reapproximated with a running 2-0 Vicryl suture. Next, i placed 2 Kocher clamps at the 3 and 9 o'clock position at the level of the hymenal ring, and a pyramidal area of epithelium was removed from the perineal body up to the level of the hymenal ring. The posterior vaginal vault was incised for the distance of approximately 3 cm. The rectovaginal fascia was reflected by blunt and sharp dissection, and again a series of 0 Vicryl sutures in an interrupted fashion were placed in the posterior vaginal vault to reapproximate the bulbocavernosis muscles of the perineal body. Excess vaginal tissue was again excised. A separate 2-0 Vicryl running suture was continued to reapproximate the vaginal mucosa and subsequently the perineal body in an episiotomy-like closure. Three interrupted 2-0 Vicryl sutures were placed in the perineal body for additional support, as the patient has a strong history of COPD and coughing. Cystourethroscopy was performed using a 70- and 30-degree lens, 0.2 ml of sodium fluorescein were instilled such that I could document patent ureteral orifices bilaterally and no evidence of bladder injury.

    Any help would be appreciated!!!!

  2. #2
    Does anyone have any ideas?

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