Laparoscopic repair of recurrent left inguinal hernia
PATIENT INFORMATION: NAME: COUSINS, Ralph PATIENT NUMBER: ASUCase027 DATE OF SURGERY: 04-13-YYYY SURGEON: Edward R. Hess M.D. ASSISTANT SURGEON: Matthew Bowers, M.D. PREOPERATIVE DIAGNOSIS: Recurrent left inguinal hernia POSTOPERATIVE DIAGNOSIS: Same PROCEDURES: Laparoscopic repair of recurrent left inguinal hernia DESCRIPTION OF PROCEDURE: The patient was brought in the Operating Room, placed in supine position on the operating table and after adequate general endotracheal anesthesia was instituted a foley cath was inserted and he was prepped and draped in the usual fashion for a laparoscopic inguinal hernia repair. A 1 cm. Incision was made on the inferior umbilical fold transversely in the midline just through the skin. A Verres needle was placed through that area and then through the midline fascia and into the peritoneal cavity. CO2 insufflation was begun on low flow. We had about 1 liter to 1 % liters of CO2 present. I then increased the flow to higher flow until he had an intraperitoneal pressure of about 15 mm. of mercury. The Verres needle was then removed. We had about 3-31/2 liters of CO2 present in the peritoneal cavity. The 10-11 mm. endopath ethicon trocar was placed through that opening, through the midline fascia and into the peritoneum and into the peritoneal cavity. The patient was placed in Trendelenburg position. The trocar was removed and a 0- 10 mm. laparoscopywith camera attachment was placed through the port and into the peritoneal cavity. Examination revealed no specific abnormalities except a small, what was probably recurrent direct hernia on the left, no hernia on the right that I could visualize. The two lateral ports were then placed. A I cm. Horizontal skin incision was made about the level of the umbilicus lateral to the rectus muscle in the left lower quadrant area and another 10-11 mm. endopath ethicon trocar was placed in the peritoneal cavity under direct visualization. A 5.5 mm. reducer was placed over that to alternately switch instruments as we needed to go along. The right lower quadrant port was placed at the level of the umbilicus, lateral to the rectus muscle. A 1 cm. Horizontal incision was made in the skin and another 10-11 mm. endopath ethicon trocar was placed into the peritoneal cavity under direct visualization. When the trocar was removed via the port a 5.5 mm. reducer was also placed over that end to accommodate smaller instruments. I then used instruments in the right lower quadrant and the left lower quadrant ports to visualize the left inguinal area. As I said, it was a small, probably direct, left inguinal hernia. The area was bulging in that area. Around the femoral area it was also somewhat of a bulge but I believe this was truly a direct hernia that was recurring. The Metzenbaum scissors, disposable, with cautery set at 50 was then used to make a peritoneal incision from the lateral umbilical fold medially in a lateral fashion then across the top of the inguinal area, taking care to avoid the epigastric vessels, and then out laterally well beyond the internal inguinal ring area. Prior to doing this, however, the femoral vessels, the epigastric vessels, and the intra-alveolar fold here, the spermatic cord and vessels were seen, all identified as was the internal ring. So, we went ahead then and used crile clamps, one in each hand, to begin dissecting the peritoneum off the subcutaneous tissue and other structures in that location in the inguinal area
hi i am looking for the icd 10 cm, cpt and APC code for this case once again im not the original person who posted this case
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