CPT® Code 49190

1. Indications

The procedure is indicated for the excision or destruction of intra-abdominal tumors or cysts that meet specific criteria. The following conditions warrant this surgical intervention:

• Primary Tumors - These are tumors that originate in the abdominal organs.
• Secondary Tumors - These tumors have metastasized to the abdominal cavity from other sites in the body.
• Cysts - Fluid-filled sacs that may develop in the abdominal cavity.
• Size of Tumors or Cysts - The total maximum length of the tumors or cysts must exceed 30 centimeters to qualify for this procedure.

2. Procedure

The procedure involves several critical steps to ensure the effective excision or destruction of the tumors or cysts:

• Step 1: Incision - An incision is made in the abdominal wall, extending to the level of the peritoneum. Care is taken to avoid damaging surrounding organs.
• Step 2: Accessing the Peritoneal Cavity - The peritoneum is grasped, elevated, and incised to open the abdominal cavity. This allows for direct access to the internal structures.
• Step 3: Exploration - The abdominal cavity is thoroughly explored both visually and by palpation to identify all masses and abnormalities present.
• Step 4: Dissection of Adhesions - Any adhesions are carefully dissected to expose the abdominal viscera, ensuring a clear view of the tumors or cysts.
• Step 5: Tumor Identification - The location, size, and extent of the primary mass are documented, and surrounding tissues are packed to provide better access to the mass.
• Step 6: Tumor Excision or Destruction - The tumor is either meticulously resected, ensuring that blood vessels supplying adjacent organs are preserved, or it is destroyed using electrocautery or laser techniques.
• Step 7: Repeat as Necessary - The excision or destruction process is repeated for all identified tumors until complete removal or ablation is achieved.
• Step 8: Irrigation and Inspection - The abdominal cavity is irrigated with an antibiotic solution, and a final inspection is conducted to check for any injuries before proceeding to closure.
• Step 9: Closure - The omentum is replaced over the abdominal contents, drains are placed if necessary, and the fascia and other soft tissues are closed securely.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications that may arise from the surgery. Patients are typically observed for signs of infection, bleeding, or any adverse reactions to anesthesia. Recovery may involve pain management and gradual resumption of normal activities, depending on the extent of the surgery and the patient's overall health. Follow-up appointments are essential to assess healing and to ensure that any remaining tumors or cysts are monitored appropriately. The placement of drains, if utilized, will also require care to prevent infection and ensure proper drainage.