CPT® Code 49654

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1. Indications

The laparoscopic surgical repair of an incisional hernia, as indicated by CPT® Code 49654, is performed under specific circumstances. The following conditions warrant this procedure:

• Incisional Hernia A protrusion at the site of a previous surgical incision that has not healed properly, leading to a defect in the abdominal wall.
• Reducible Hernia The hernia contents can be pushed back into the abdominal cavity, allowing for a less complicated surgical repair.

2. Procedure

The laparoscopic repair of an incisional hernia involves several critical procedural steps, which are outlined as follows:

• Step 1: Preparation and Anesthesia The patient is positioned appropriately, and general anesthesia is administered to ensure comfort and immobility during the procedure.
• Step 2: Establishing Pneumoperitoneum A small incision is made at a site distant from the prior abdominal incision. A trocar is inserted through this incision to create an entry point into the abdominal cavity, and carbon dioxide gas is introduced to inflate the abdomen, allowing for better visualization and access.
• Step 3: Insertion of the Laparoscope The laparoscope is introduced through the trocar, providing a visual field for the surgeon. Additional portal incisions are made under direct vision to allow for the insertion of surgical instruments necessary for the repair.
• Step 4: Examination and Dissection The abdominal wall is thoroughly examined, and any adhesions present are lysed to free the hernia sac. The extent of the hernia is evaluated to determine the best approach for repair.
• Step 5: Reducing the Hernia The contents of the hernia are carefully reduced back into the abdominal cavity. The edges of the hernia defect are cleared of peritoneum and fat to prepare for closure.
• Step 6: Repairing the Hernia Defect The hernia defect may be closed using primary sutures. If a mesh is indicated, the defect is measured, and the mesh is cut to the appropriate size. The mesh is then inserted and positioned over the reduced hernia defect.
• Step 7: Securing the Mesh The mesh is affixed to the abdominal wall using tacks or sutures to ensure stability and prevent recurrence of the hernia.
• Step 8: Conclusion of the Procedure After the repair is completed, the laparoscope and surgical instruments are removed. The pneumoperitoneum is released, and the portal incisions are closed with sutures or staples as appropriate.

3. Post-Procedure

Following the laparoscopic repair of an incisional hernia, patients can expect a recovery period that typically involves monitoring for any complications such as infection or recurrence of the hernia. Pain management is provided as needed, and patients are usually encouraged to engage in light activities shortly after the procedure, with gradual return to normal activities as tolerated. Follow-up appointments are essential to assess the healing process and ensure that the repair is successful. Specific post-operative care instructions will be provided by the surgical team, including guidelines on activity restrictions and signs of potential complications to watch for during recovery.