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A sling operation for stress incontinence is a minimally invasive surgical procedure performed via laparoscopy. This technique is specifically designed to address stress urinary incontinence, a condition characterized by involuntary leakage of urine during activities that increase abdominal pressure, such as coughing, sneezing, or exercise. The procedure utilizes either a fascial graft, which is a strip of tissue taken from the patient's own body, or a synthetic material to create a supportive sling that is placed under the urethra. The laparoscopic approach involves making several small incisions in the abdomen, allowing for the insertion of a laparoscope and other surgical instruments. This method is advantageous as it typically results in less postoperative pain, reduced recovery time, and minimal scarring compared to traditional open surgery. The operation aims to provide support to the bladder neck and urethra, thereby improving urinary control and quality of life for patients suffering from this condition.
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The sling operation for stress incontinence is indicated for patients experiencing involuntary urine leakage associated with activities that increase abdominal pressure. This condition, known as stress urinary incontinence, may arise from various factors, including weakened pelvic floor muscles, previous childbirth, or surgical procedures affecting the pelvic region. The procedure is typically recommended when conservative treatments, such as pelvic floor exercises or medications, have not provided sufficient relief from symptoms.
The sling operation for stress incontinence involves several key procedural steps that are performed laparoscopically. Initially, if a fascial autograft is utilized, a small incision is made over the lower abdomen or thigh to remove a strip of fascia. Following this, four small incisions are created in the abdomen, through which trocars are inserted to facilitate access to the abdominal cavity. A laparoscope is then introduced to provide visualization of the surgical field. The surgeon dissects the retropubic space to create a pathway for the graft. Subsequently, the fascial or synthetic graft is introduced laparoscopically into the retropubic space. An incision is made in the anterior vaginal wall directly over the bladder neck to allow access for the sling placement. A small tunnel is created on one side of the bladder neck, and a long clamp is advanced through the vaginal incision into the retropubic space. The surgeon then grasps one end of the fascial or synthetic sling and pulls it into the vagina. The sling is positioned under the urethra and around the bladder neck, and the other end is returned to the retropubic space through a second small tunnel on the opposite side of the bladder neck. Finally, the ends of the sling are secured by suturing them to the Cooper's ligament, pelvic fascia, or abdominal wall. After confirming proper placement and tension of the sling, the laparoscope and surgical instruments are removed, and the incisions in both the abdomen and vaginal wall are closed.
Post-procedure care following a sling operation for stress incontinence typically involves monitoring for any immediate complications, such as bleeding or infection. Patients may be advised to limit physical activity for a specified period to promote healing. Pain management may be necessary, and patients are often instructed on how to care for their incisions. Follow-up appointments are essential to assess recovery and the effectiveness of the procedure. Patients may also receive guidance on pelvic floor exercises to further strengthen the pelvic muscles and improve urinary control. It is important for patients to report any unusual symptoms, such as persistent pain or changes in urinary function, to their healthcare provider.
| Short Descr | LAPARO SLING OPERATION | Medium Descr | LAPAROSCOPY SLING OPERATION STRESS INCONT | Long Descr | Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 106 - Genitourinary incontinence procedures |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | GC | This service has been performed in part by a resident under the direction of a teaching physician | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Medium description changed. |
| 2000-01-01 | Added | First appearance in code book in 2000. |
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