CPT® Code 49611

1. Indications

The repair of an omphalocele is indicated for patients presenting with this congenital defect, which may be diagnosed at birth or during prenatal imaging. The procedure is necessary to address the protrusion of intra-abdominal organs and to prevent complications such as infection, strangulation of the herniated organs, and other associated morbidity. The timing of the second stage repair is typically determined based on the patient's growth and development, as well as the condition of the skin flaps and the hernia.

• Congenital Omphalocele The primary indication for the procedure is the presence of an omphalocele, which requires surgical intervention to repair the abdominal wall defect.
• Prevention of Complications The procedure aims to prevent potential complications associated with the herniated organs, including infection and strangulation.
• Restoration of Abdominal Wall Integrity The repair is necessary to restore the normal anatomy and function of the abdominal wall.

2. Procedure

The procedure for the second stage repair of an omphalocele, coded as CPT® 49611, involves several critical steps to ensure the successful closure of the abdominal wall defect. The first step is to carefully reopen the previously created skin flaps that were developed during the first stage of the repair. This is done with precision to avoid damaging the underlying tissues. Once the skin flaps are opened, the surgeon assesses the condition of the herniated organs and the surrounding tissues. The next step involves the careful reduction of the herniated contents back into the abdominal cavity. This step is crucial as it allows for the restoration of normal anatomical positioning of the intra-abdominal structures. After the reduction, the surgeon proceeds to repair the abdominal wall defect. This is typically achieved by suturing the fascia and muscle layers together, ensuring that the abdominal wall is reinforced and secure. Finally, the skin flaps are closed over the repaired area, completing the procedure and restoring the integrity of the abdominal wall.

• Step 1: Reopening Skin Flaps The surgeon carefully reopens the skin flaps that were created during the first stage of the repair to access the herniated organs.
• Step 2: Assessment of Herniated Organs The condition of the herniated organs and surrounding tissues is assessed to ensure they are viable and can be safely reduced.
• Step 3: Reduction of Herniated Contents The herniated organs are gently reduced back into the abdominal cavity, restoring their normal anatomical position.
• Step 4: Repair of Abdominal Wall Defect The abdominal wall defect is repaired by suturing the fascia and muscle layers together, reinforcing the abdominal wall.
• Step 5: Closure of Skin Flaps The skin flaps are then closed over the repaired area, completing the surgical procedure.

3. Post-Procedure

After the second stage repair of an omphalocele, patients typically require close monitoring for any signs of complications, such as infection or issues with the healing of the surgical site. Post-operative care may include pain management, wound care, and monitoring for any signs of hernia recurrence. The expected recovery period can vary, but patients are generally advised to avoid strenuous activities for a specified duration to allow for proper healing. Follow-up appointments are essential to assess the surgical site and ensure that the abdominal wall is healing appropriately. Additional interventions may be necessary if complications arise during the recovery process.