CPT® Code 49656

Deleted

1. Indications

The laparoscopic surgical repair of a recurrent incisional hernia is indicated for patients who present with the following conditions:

• Recurrent Incisional Hernia A hernia that has reappeared at the site of a previous surgical incision, indicating a failure of the initial repair.
• Reducible Hernia A hernia that can be pushed back into the abdominal cavity, allowing for surgical intervention.

2. Procedure

The procedure for laparoscopic repair of a recurrent incisional hernia involves several key steps:

• Step 1: Incision and Trocar Placement A small incision is made at a location distant from the prior abdominal incision and the hernia defect. A trocar is then inserted through this incision to establish pneumoperitoneum, which is the inflation of the abdominal cavity with gas to create a working space for the surgery.
• Step 2: Introduction of Laparoscope The laparoscope, a specialized camera, is introduced into the abdominal cavity through the trocar. This allows the surgeon to visualize the internal structures on a monitor.
• Step 3: Additional Portal Incisions Under direct vision, additional portal incisions are made to facilitate the insertion of surgical instruments needed for the repair.
• Step 4: Lysis of Adhesions Any adhesions, which are bands of scar tissue that may be present, are lysed or cut to free the hernia and surrounding tissues.
• Step 5: Examination of the Abdominal Wall The surgeon examines the abdominal wall to assess the extent of the hernia and the condition of the surrounding tissues.
• Step 6: Preparation of the Hernia Defect The edges of the hernia defect are cleared of peritoneum and fat to prepare for closure or mesh placement.
• Step 7: Marking the Defect The location of the hernia defects is marked on the overlying skin to guide the repair process.
• Step 8: Reduction of Hernia Contents The contents of the hernia are reduced, meaning they are pushed back into the abdominal cavity.
• Step 9: Closure of the Hernia Defect The hernia defect may be closed using primary sutures, or if necessary, a mesh insert is utilized. If mesh is required, the defect is measured, and the mesh is cut to size, inserted, and positioned over the defect.
• Step 10: Affixing the Mesh The mesh is affixed to the abdominal wall using tacks or sutures to ensure stability and support.
• Step 11: Removal of Instruments The laparoscope and surgical instruments are removed from the abdominal cavity.
• Step 12: Closure of Incisions The pneumoperitoneum is released, and the portal incisions are closed to complete the procedure.

3. Post-Procedure

After the laparoscopic repair of a recurrent incisional hernia, patients can expect a recovery period that may vary based on individual circumstances. Post-procedure care typically includes monitoring for any signs of complications, such as infection or recurrence of the hernia. Patients are often advised to follow specific guidelines regarding activity levels, including restrictions on heavy lifting and strenuous exercise for a designated period. Pain management may be necessary, and follow-up appointments are usually scheduled to assess healing and ensure the success of the repair.