1. Laparoscopic peritoneal dialysis catheter placement (CPT 49324)
2. Omentopexy (CPT 49326)
The patient was met in the preoperative holding area, patient, consent, site and procedure to be performed confirmed. All questions answered. The patient was transported to the operating room and placed on the table in supine position, boney areas padded, sequential compression devices applied to the bilateral lower extremities and secured with straps. General anesthesia was induced, and patient was intubated without issue. Preoperative Ancef was given. The abdomen was prepped and draped in the normal sterile fashion. Timeout was done and all were in agreement.
I accessed the abdomen was accessed with 5 mm Optical trocar entry in the right upper quadrant and the abdomen insufflated to 15 mmHg. There was no injury on entry. An additional 5 mm and 8 mm ports were placed under direct vision the right hemi abdomen without injury. Using a 5 mm trocar through a periumbilical incision a tract was created in the preperitoneal space towards the pubis and entered into the peritoneal cavity. The wire was passed, the dilator next and sheath and then the peritoneal dialysis catheter was fed into the pelvis under vision. The proximal cuff was placed below the level of the fascia, and the distal end of the tube was tunneled out through a left upper quadrant incision with the distal cuff in the subcutaneous tissue. We tested the catheter by instilling 1L of normal saline and ensuring it was adequately drained. A heparin flush was instilled.
Next, I did an omentopexy to the anterior abdominal wall with size 2-0 Stratafix Monocryl spiral suture. The operative field was noted to be hemostatic. I desufflated the abdomen. The skin incisions were closed with size 4-0 Monocryl in a running fashion and dressed with Dermabond. The exit site of the catheter was dressed with bacitracin, an antimicrobial ring, abdominal pads and secured with occlusive Tegaderm. The patient was liberated from anesthesia an extubated without issue and transported to the PACU in stable condition. Final counts were correct.
Dr. [attending] was present or available for all critical aspects of the case.
Service: GS (green)
Author: Garrett Skinner