CPT® Code 49652

Deleted

1. Indications

The laparoscopic repair of ventral, umbilical, spigelian, or epigastric hernias is indicated for patients presenting with the following conditions:

• Ventral Hernia - A hernia occurring at the site of a previous abdominal incision, often due to weakness in the abdominal wall.
• Umbilical Hernia - A protrusion of abdominal contents through the abdominal wall at the umbilicus, which may be reducible.
• Spigelian Hernia - A hernia that occurs through the semilunar line, leading to the protrusion of abdominal contents.
• Epigastric Hernia - A hernia characterized by the protrusion of tissue through the linea alba in the midline of the abdomen.

2. Procedure

The laparoscopic repair procedure involves several critical steps to ensure effective hernia correction:

• Step 1: Incision and Access - A small incision is made at a location distant from any previous abdominal incisions and the hernia defect. A trocar is then inserted to establish pneumoperitoneum, allowing for the inflation of the abdominal cavity.
• Step 2: Introduction of Laparoscope - The laparoscope is introduced through the trocar, providing visualization of the abdominal cavity. Additional portal incisions are made under direct vision to facilitate the insertion of surgical instruments.
• Step 3: Adhesion Lysis - Any adhesions present in the abdominal cavity are lysed to free up the hernia and surrounding structures for better access and evaluation.
• Step 4: Examination of the Abdominal Wall - The abdominal wall is thoroughly examined to assess the extent of the hernia. The edges of the hernia defect are cleared of peritoneum and fat to prepare for repair.
• Step 5: Marking the Defect - The locations of the hernia defects are marked on the overlying skin to guide the repair process.
• Step 6: Hernia Reduction - The contents of the hernia are reduced back into the abdominal cavity, ensuring that the hernia sac is empty before closure.
• Step 7: Closure of the Defect - The hernia defect may be closed using primary suture techniques, or a mesh insert may be required. If mesh is necessary, the defect is measured, and the mesh is cut to size, inserted, and positioned over the reduced hernia defect.
• Step 8: Mesh Affixation - The mesh is affixed to the abdominal wall using tacks or sutures to ensure stability and prevent recurrence of the hernia.
• Step 9: Removal of Instruments - After the repair is complete, the laparoscope and surgical instruments are removed, and the pneumoperitoneum is released.
• Step 10: Closure of Incisions - Finally, the portal incisions are closed to complete the procedure.

3. Post-Procedure

Post-procedure care following laparoscopic repair of a ventral, umbilical, spigelian, or epigastric hernia typically includes monitoring for any signs of complications, such as infection or recurrence of the hernia. Patients are usually advised on activity restrictions to allow for proper healing, and follow-up appointments may be scheduled to assess recovery progress. Pain management strategies may also be discussed to ensure patient comfort during the recovery phase.