Would appreciate advice on coding op note below:
The patient was placed on the operating table in the supine
position. After adequate general anesthesia was secured, the abdomen was
prepped and draped in the usual fashion. A Foley catheter had been placed
preoperatively, as well as SCD hose. The patient has had a gram of Mefoxin
as well. A midline incision is made removing upper midline scar and carried
out around the umbilicus. The fascia is noted to be markedly thickened. On
entering the peritoneal cavity, the bowel is noted to make up a large
phlegmon with edema between loops of bowel and edematous mesentery. Once
pelvic adhesions tethering this mass of bowel are lysed, we then elevated
this bowel mass and began with lysis of adhesion. We started at the ileum.
There were numerous adhesions between loops of bowel, as well as intra loop
adhesions, also adhesions involving the mesentery. We noted a single loop of
jejunum adherent to the anterior abdominal wall below the umbilicus. This
was a hairpin turn of small bowel and felt to be the source of her partial
small bowel obstruction. We continued lysing adhesions until all adhesions
were lysed from the ileum to the ligament of Treitz. We did note the
jejunojejunostomy anastomosis was intact. The jejunum did pass through the
transverse mesocolon to be anastomosed to the stomach. This portion of the
jejunum wall was edematous, but there was no evidence of ischemia throughout
close examination of her bowel. We did have two areas where the seromuscular
layer had been torn. This was closed with horizontal sutures of 3-0 silk.
We did not incur any inadvertent enterotomies. At the conclusion of the
procedure, we copiously irrigated the abdomen with normal saline and at this
point placed Seprafilm within the pelvis, then allowing small bowel contents
to return to their normal anatomic position, we placed additional Seprafilm
just superficial to the returned small bowel. We then pulled omentum over
this and as well placed Seprafilm on either side of the abdominal cavity, as
well as in the midline. Thus, we used approximately five pieces of Seprafilm
and at this point two retention sutures were placed of #2 Ethilon. The
fascia was then closed with running suture of #1 Prolene. These met in the
middle. We tied these and then closed the skin with staples. The retentions
were then tied over bridges. Dressing placed, as well as abdominal binder
and the patient was transferred to the recovery room in stable. Estimated
blood loss was approximately 100 to 150 cc. She tolerated the procedure well.
