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EXPLORATORY LAP WITH RESECTION OF GASTRIC FISTULA

Mary Posted Tue 21st of October, 2014 16:31:23 PM

I am so confused - I wondered if clearer heads than mine could help!

After informed consent was obtained, patient brought to the OR. Attention is given to the left upper quad area where the old PEG TUBE SITE was approached and a transverse was made at this site on each side with 3-4 cm for adequate exposure. The subcutaneous tissue was dissected away from the old stoma site. Further dissection thru the subcutaneous tissue and fascia revealed a persistent gastric fistula connected to the subcutaneous tissue and dermis.

At this point, exploratory lap was carried out with lysis of adhesions around the stoma site requiring an opening in the fascia on each side and exposure of the stomach. After having freed up all adhesions, the gastric fistula was brought up and resected a 4-5 cm opening in the stomach. This opening was closed using a running 3-0 chromic on a Lembert type stitch on the inner layer whereupon several muscular clips were used to close the outer layer in the imbricating type of manner. These were interrupted sutures.

The stomach was then placed back down to its normal anatomic position in the intraabdominal cavity and after ascertaining tha the final needle and instrument count was correct, the fascial defect was repaired using #0 vicyl suture. Subcutaneous tissue was copiously irrigated after a culture was obtained and a subcutaneous drain was placed for long-term drainage. A 4-0 running Ethilon was used to close the dermis and Mastisol was applied to the skin for sealing the skin to prevent colostomy contamination.

Prior to closure, a drain was brought out thru epigastric area away from the incision and away from the colostomy and a closed suction drain and a channel drain was secured with 4-0 Ethilon suture. Each area was then cleaned, dried and dressed in the usual manner. The patient tolerated the procedure very well. She was awakened and placed back onto her portable ventilator and taken to recovery having tolerated the procedure very well.

PREOP DX - CHRONIC CELLULITIS OLD PERCUTANEOUS ENDOSCOPIC TUBE SITE, RULE OUT FOREIGN BODY

POSTOP DX - PERSISTENT GASTRIC FISTULA WITH CHRONIC CELLULITIS

SuperCoder Answered Wed 22nd of October, 2014 02:22:46 AM

AAE does not provide coding for operative reports and chart notes. SuperCoder offers SuperCoding on Demand (SOD) (http://www.supercoder.com/coding-answers/coding-on-demand) for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail customerservice@supercoder.com for more information.

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