CPT® Code 49491

1. Indications

The procedure is indicated for the following conditions:

• Preterm Infants The repair is specifically for preterm infants who are younger than 37 weeks gestation at birth.
• Age Requirement The procedure is performed from birth up to 50 weeks post-conception age.
• Reducible Inguinal Hernia The procedure is indicated for a reducible inguinal hernia, where the contents of the hernia sac can be pushed back into their normal position.
• Presence of Hydrocele The procedure may also be indicated if a hydrocele is present, which is an accumulation of excess fluid in the sac surrounding the testis.

2. Procedure

The procedure involves several detailed steps to ensure the successful repair of the inguinal hernia:

• Incision A small incision is made over the external ring of the groin area. This allows access to the underlying structures.
• Elevation and Dissection Scarpa's fascia is elevated and incised to expose the underlying cord structures. The cord is then isolated and dissected free of surrounding fat, allowing for clear visibility of the external ring.
• Exposure of Hernia Sac The cord is elevated, and the overlying fascia is opened distal to the external ring to expose the hernia sac. This step is crucial for accessing the contents of the hernia.
• Inspection of Contents The hernia sac is dissected free from surrounding tissue and opened. The contents are inspected, and loops of bowel proximal and distal to the obstruction are extracted and examined for health and peristalsis.
• Repair of Healthy Bowel If the bowel is determined to be healthy and peristalsis is present, the hernia is repaired. The distal end of the sac is transected, and the proximal stump is freed up through the internal ring to the level of the extraperitoneal fat.
• Emptying and Ligation of Sac The sac is rotated to ensure it is emptied of all hernia contents before it is ligated. The excess stump is then excised to prevent future complications.
• Closure of Cord Structures The cord structures are returned to the peritoneal cavity, and the opening in the cord covering is sutured closed to restore integrity.
• Closure of Incision Scarpa's fascia is closed, and the skin is reapproximated to complete the procedure.
• Hydrocele Management If a hydrocele is present, it is drained, and a partial excision of the tunica vaginalis may also be performed to address the fluid accumulation.
• Female Considerations In females, the procedure is similar, but the hernia sac must be explored for the presence of the ovary. If the ovary is not contained in the sac, the round ligament is ligated together with the sac. If the ovary is present and healthy, it is returned to the abdomen, ensuring that the fallopian tube is not damaged. Once the ovary is safely returned, the sac is clamped and transected.

3. Post-Procedure

Post-procedure care involves monitoring the infant for any signs of complications, such as infection or recurrence of the hernia. The infant may require pain management and should be observed for normal bowel function following the repair. Parents or caregivers will be instructed on how to care for the surgical site and recognize any concerning symptoms that may require medical attention. Follow-up appointments will be necessary to ensure proper healing and assess the success of the procedure.