CPT® Code 49495

1. Indications

The procedure described by CPT® Code 49495 is indicated for the following conditions:

• Initial Inguinal Hernia Repair This procedure is performed on full-term infants younger than six months or preterm infants older than 50 weeks post-conception age and younger than six months at the time of surgery.
• Reducible Hernia The hernia must be reducible, meaning that the contents of the hernia sac can be pushed back into their normal position.
• Presence of Hydrocele (optional) The procedure may also address a hydrocele, which is an accumulation of fluid in the sac surrounding the testis, although this is not a requirement for the surgery.

2. Procedure

The surgical procedure for the repair of an inguinal hernia involves several detailed steps:

• Step 1: Incision and Exposure A small incision is made over the external ring of the groin area. The surgeon elevates and incises Scarpa's fascia to gain access to the underlying structures. This step is crucial for exposing the hernia sac and the cord structures.
• Step 2: Isolation of the Cord The cord is carefully isolated and dissected free of surrounding fat. This allows the surgeon to expose the external ring and prepare for the next steps in the procedure.
• Step 3: Hernia Sac Exposure The cord is elevated, and the overlying fascia is opened distal to the external ring. This exposes the hernia sac, which is then dissected free from surrounding tissue to allow for inspection and repair.
• Step 4: Inspection of Contents The hernia sac is opened, and the contents are inspected. Loops of bowel proximal and distal to the obstruction are extracted and examined to ensure they are healthy and that peristalsis is present.
• Step 5: Repair of the Hernia If the bowel is determined to be healthy, 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.
• Step 6: Ligation and Excision 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.
• Step 7: Closure of the Cord Structures The cord structures are returned to the peritoneal cavity, and the opening in the cord covering is sutured closed to restore normal anatomy.
• Step 8: Closure of the Incision Scarpa's fascia is closed, and the skin is reapproximated to complete the procedure. If a hydrocele is present, it is drained, and a partial excision of the tunica vaginalis may also be performed.
• Step 9: Special Considerations for Females In female patients, the procedure is similar, but the surgeon must explore the hernia sac for the presence of the ovary. If the ovary is not contained within the sac, the round ligament is ligated along 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 for an inguinal hernia repair includes monitoring the infant for any signs of complications, such as infection or recurrence of the hernia. The surgical site should be kept clean and dry, and parents or caregivers should be instructed on how to care for the incision. Follow-up appointments are typically scheduled to assess healing and ensure that the infant is recovering appropriately. Any concerns regarding the infant's recovery, such as excessive swelling, redness, or discharge from the incision site, should be reported to a healthcare provider immediately. Additionally, parents should be advised on signs of bowel obstruction or other complications that may arise after the surgery.