I have a patient that 11 months after her BPD DS developed a leak and was taken back to surgery. Here is the OP - I am looking at maybe 44640 or 44650 - any thoughts??

Under direct vision with the laparoscope an additional LUQ 5 mm stab incision was made and trocar inserted into abdomen. There were some adhesions up in the right upper quadrant in the midline and these were taken using sharp and harmonic scalpel dissection. With these taken down, we could place additional right sided abdominal trocars. There were some adhesions up in the liver edge and there were lysed sharply. Following this, a small stab incision was made in the subxiphoid area, and Nathanson liver retractor was positioned to expose the hiatus. Dissection was carried out up toward the GE junction along the prior gastric sleeve resection. Proximally, near the GE junction, there was significant inflammation. We were able to identify the area of presumptive perforation which had a large amount of inflammation and this was fully exposed and this portion of the gastric sleeve mobilized. At this point, intraoperative EGD was performed and we confirmed that this was the area of the leak. This was then grasped and the area of the leak and fistulation resected with the firing of an Endocutter stapler. We inspected the resected portion of the specimen and could indeed find the fistula tract at the area of the perforation. The staple line at this point was oversewn with running 2-0 silk to "Lembert" the staple line. We once again checked the repair using the EGD with air insufllation under water and found no evidnce of leak. Omental pedicle was brought up and tacked then over the staple line to further reinforce this. The diaphragm was somewhat patulous at the hiatus and this was also closed with interrupted 0 silk suture. Hemostasis was assured throughout. Pneumoperitoneum was allowed to desufflate and the trocars were removed. The drain was secured in place with 3-0 nylon suture. The skin of all incisions was closed and subcuticular 4-0 Monocryl. The patient tolerated the procedure well and there were no complicationis noted. She was transferred to Recovery Room in stable condition.


Thanks for any input you might have on this.