Sep 24th, 2013 - ll197902
Open Omentectomy with Laparoscopic Hernia Repair
I'm unsure if the open omentectomy is separately billable. Any help would be greatly appreciated.
DESCRIPTION OF OPERATION: The patient was prepped and draped in the usual sterile
fashion after satisfactory achievement of anesthesia. We went ahead and did a
cutdown in the left upper quadrant near Palmer's point and into the peritoneal cavity
by direct cutdown technique. 0-Vicryl pursestring was placed in the peritoneal
layer. The Hasson cannula was inserted and secured and the abdomen was insufflated.
A 12-mm left lower quadrant port was placed and a 5-mm right upper quadrant port was
placed. The hernia involved omentum that was stuck up. There was some bowel nearby
which was carefully teased away using sharp dissection with Metzenbaum scissors.
There was no more bowel in the area. There was omentum up in the hernia which was
totally reducible and really kind of rock hard on physical exam. We went ahead and
disconnected the fat. We totally the resected the omentum. We then placed a piece
of mesh in the usual fashion and tacked it using the AbsorbaTack circumferentially
very nicely creating a nice repair. The ports were removed under direct vision. The
cutdown site was closed using 0-Vicryl suture. Skin staples were applied. We then
went ahead and made an incision over the mass and it was incarcerated and as it
turned out necrotic, strangulated fat. We totally removed this with its sac. We
then closed the fascia over the top using running 1 suture and everything went really
well and looked great. This closure of the fascia over the top was done with
1-Vicryl and I felt that was appropriate given the fact that the mesh was already in
place. Everything looked great. We thoroughly irrigated. There was good
hemostasis. Subcutaneous tissues were reapproximated closing the dead space using
Vicryl suture and the skin using skin staples. Sterile dressings were applied. The
patient tolerated the procedure well and is in stable condition at this time. There
were no complications.
Thank you in advance for your help!! :)