CPT® Code 49600

1. Indications

The procedure for the repair of a small omphalocele is indicated in the following situations:

• Congenital Defect The presence of a small omphalocele at birth, characterized by a defect in the umbilical ring.
• Size of the Defect The defect is classified as small, typically measuring between 1 to 2 centimeters in diameter.
• Involvement of Bowel The omphalocele contains one or two loops of small bowel, necessitating surgical intervention to prevent complications.

2. Procedure

The surgical procedure for the repair of a small omphalocele involves several critical steps:

• Step 1: Examination of the Omphalocele The surgeon begins by assessing the omphalocele, which may be either unopened or have a ruptured sac. This initial examination is crucial to determine the extent of the defect and the condition of the bowel contained within the sac.
• Step 2: Excision of the Sac If the omphalocele sac is present, it is excised to facilitate access to the bowel and to prepare for the repair of the abdominal wall. This step is essential to remove any compromised tissue and to ensure a clean surgical field.
• Step 3: Bowel Examination Following the excision, the bowel is carefully examined to rule out any additional problems, such as ischemia or other abnormalities that may require further surgical intervention. This step is critical to ensure the health and viability of the bowel.
• Step 4: Creation of Space in the Abdomen If the bowel is found to be healthy, the surgeon then creates sufficient space in the abdominal cavity. This is accomplished by inserting the fingers of both hands into the abdominal cavity and gently pushing outward on the abdominal wall, allowing for adequate room to reposition the bowel.
• Step 5: Repositioning the Bowel Once enough space is achieved, the surgeon carefully pushes the bowel back into the abdominal cavity, ensuring that it is properly placed and that there are no obstructions.
• Step 6: Closure of the Abdominal Wall The final step involves closing the defect in the abdominal wall. The surgeon meticulously sutures the layers of the abdominal wall together and covers the area with skin to complete the repair, ensuring that the closure is secure and promotes healing.

3. Post-Procedure

After the repair of a small omphalocele, post-procedure care is essential for recovery. Patients are typically monitored for any signs of complications, such as infection or bowel obstruction. The surgical site should be kept clean and dry, and any dressings should be changed as directed by the healthcare provider. Follow-up appointments are necessary to assess healing and to ensure that the abdominal wall is properly closed. Patients may also receive guidance on activity restrictions and care of the surgical site to promote optimal recovery.