CPT® Code 49655

Deleted

1. Indications

The laparoscopic surgical repair of an incarcerated or strangulated incisional hernia, as indicated by CPT® Code 49655, is performed under specific circumstances. The following conditions warrant this procedure:

• Incarcerated Hernia - This condition occurs when a portion of the intestine or other tissue becomes trapped in the hernia sac, preventing it from being pushed back into the abdominal cavity.
• Strangulated Hernia - This is a more severe condition where the blood supply to the trapped tissue is compromised, leading to potential necrosis. Immediate surgical intervention is necessary to prevent serious complications.

2. Procedure

The laparoscopic repair of an incarcerated or strangulated hernia involves several critical steps, which are detailed 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, and a trocar is inserted to create a pneumoperitoneum, which is the inflation of the abdominal cavity with gas to provide a working space for the laparoscope and instruments.
• Step 3: Insertion of Laparoscope - The laparoscope is introduced through the trocar, allowing the surgeon to visualize the abdominal cavity on a monitor. Additional portal incisions are made under direct vision for the insertion of surgical instruments.
• Step 4: Lysis of Adhesions - Any adhesions that may be present are carefully lysed to free the hernia sac and surrounding structures, facilitating access to the hernia defect.
• Step 5: Evaluation of the Hernia - The extent of the hernia is assessed, and the hernia sac is opened to inspect the incarcerated loop of bowel or other contents. If strangulation is present, necrotic tissue is identified.
• Step 6: Management of Strangulated Tissue - In cases of strangulation, any necrotic tissue, which may include omentum or bowel, is resected and placed in a retrieval bag for removal from the abdominal cavity.
• Step 7: Hernia Repair - The hernia contents are reduced back into the abdominal cavity. The hernia defect is then closed using primary suture techniques or reinforced with a mesh insert, which is cut to size and affixed to the abdominal wall using tacks or sutures.
• Step 8: Closure of Incisions - After the repair is completed, the laparoscope and instruments are removed, the pneumoperitoneum is released, and the portal incisions are closed securely.

3. Post-Procedure

Following the laparoscopic repair of an incarcerated or strangulated hernia, patients can expect specific post-procedure care and recovery considerations. Monitoring for any signs of complications, such as infection or recurrence of the hernia, is essential. Patients are typically advised to follow a gradual return to normal activities, avoiding heavy lifting or strenuous exercise for a specified period. Pain management may be necessary, and follow-up appointments are scheduled to assess healing and ensure proper recovery.