CPT® Code 58520

1. Indications

The procedure of hysterorrhaphy, as described by CPT® Code 58520, is indicated for the repair of a ruptured uterus resulting from nonobstetrical injuries. The following conditions may warrant this surgical intervention:

• Ruptured Uterus - A tear in the uterine wall that may occur due to trauma, such as a motor vehicle accident or penetrating injury.
• Broad Ligament Hematoma - Accumulation of blood within the broad ligament due to the rupture, necessitating drainage and repair.
• Cervical and Vaginal Injuries - Ruptures that extend into the cervix and vagina, requiring careful mobilization and repair of these structures.

2. Procedure

The surgical procedure for hysterorrhaphy involves several critical steps to ensure effective repair of the ruptured uterus:

• Step 1: Abdominal Exploration - The surgeon begins by making an incision in the abdomen to gain access to the abdominal cavity. This allows for a thorough exploration to assess the extent of the injury and identify any blood clots that may need to be removed.
• Step 2: Uterine Assessment - The uterus is carefully lifted out of the abdominal cavity to visualize the site of the rupture. This step is crucial for determining the nature of the repair required based on the injury's severity.
• Step 3: Bladder Separation - The bladder is separated from the lower edge of the uterine segment to prevent injury during the repair process and to facilitate access to the uterine injury.
• Step 4: Vessel Management - Uterine vessels are located and ligated as necessary to control bleeding. This step is vital to ensure hemostasis during the procedure.
• Step 5: Hematoma Drainage - If a broad ligament hematoma is present, the round ligament is clamped, cut, and tied off. The anterior leaf of the broad ligament is then opened to allow for drainage of the hematoma, and any bleeding vessels are ligated.
• Step 6: Cervical Injury Repair - In cases where the rupture extends into the cervix and vagina, the bladder is mobilized. The upper portion of the cervical injury is sutured first, and the repair is carried down distally until the entire cervical and vaginal injury is addressed.
• Step 7: Uterine Tear Repair - The uterine tear is repaired using one or two layers of sutures, depending on the extent of the damage. Bleeding is controlled through suture ligation of any bleeding vessels encountered during the repair.
• Step 8: Drain Placement - An abdominal drain may be placed to facilitate the removal of any fluid accumulation postoperatively.
• Step 9: Final Inspection and Closure - Before closing the abdomen, the bladder is inspected to ensure it is free of injury. The abdomen is then closed in layers around the drain to promote proper healing.

3. Post-Procedure

After the completion of the hysterorrhaphy procedure, patients typically require careful monitoring for any signs of complications, such as infection or excessive bleeding. The placement of an abdominal drain may assist in managing fluid accumulation and ensuring proper healing. Recovery may involve pain management and gradual resumption of normal activities, with specific instructions provided by the healthcare team regarding follow-up care and any necessary restrictions. It is essential for patients to attend follow-up appointments to monitor the healing process and address any concerns that may arise during recovery.