CPT® Code 49565

Deleted

1. Indications

The procedure for repairing a recurrent incisional or ventral hernia is indicated in the following situations:

• Recurrent Incisional Hernia The patient has a hernia that has reappeared at the site of a previous surgical incision.
• Reducible Hernia The hernia is reducible, meaning the contents can be pushed back into the abdominal cavity.

2. Procedure

The procedure for repairing a recurrent incisional or ventral hernia involves several detailed steps:

• Step 1: Preparation The surgical site is prepared, and the patient is positioned appropriately for the procedure. An incision is made at the site of the recurrent hernia.
• Step 2: Exposure of the Hernia Sac The old scar tissue is excised, and the skin on either side of the incision is freed to expose the hernia sac. The entire sac is then opened to access the contents.
• Step 3: Dissection Any adherent omentum and bowel are carefully dissected off the inner surface of the hernia sac and the abdominal wall. This step is crucial to ensure that the hernia sac can be fully excised.
• Step 4: Sac and Tissue Removal The hernia sac, along with its peritoneal lining, scar tissue, and any suture material from previous surgeries, is excised. This step helps to eliminate any potential complications from residual tissue.
• Step 5: Closure of the Abdominal Wall The normal tissue of the linea alba is exposed, and the abdominal wall is sutured closed. If there is excess skin, it is also removed before final suturing.
• Step 6: Repair Techniques for Larger Defects For larger defects, the shoelace technique may be employed, where incisions are made in the anterior rectus sheaths to expose the rectus muscles. The hernia sac and its contents are returned to the abdominal cavity, and the linea alba is reconstructed by suturing the anterior rectus muscle strips together. In cases where the defect is particularly large, mesh reinforcement may be utilized to provide additional support.

3. Post-Procedure

After the procedure, patients are typically monitored for any signs of complications, such as infection or recurrence of the hernia. Recovery may involve pain management and instructions for activity restrictions to ensure proper healing. Follow-up appointments are essential to assess the surgical site and confirm that the hernia repair is successful. Patients should be advised on signs of complications, such as increased pain, swelling, or changes in the surgical site, and instructed to seek medical attention if these occur.