CPT® Code 49590

Code deleted. For spigelian hernia repair, see 49591-49618.

Official Description

Repair spigelian hernia

Common Language Description

A spigelian hernia repair involves the surgical correction of a specific type of hernia known as a spigelian hernia, which is characterized by the protrusion of abdominal contents through the semilunar line. This line is located at the lateral border of the rectus sheath, extending from the tip of the ninth rib to the pubic tubercle. Spigelian hernias, also referred to as lateral ventral hernias, typically occur in the lower abdomen, where they can pass through the conjoined tendon formed by the transversus abdominis and internal oblique muscles. The surgical procedure begins with a skin incision made directly over the hernia defect. If the hernia sac is located within the subcutaneous tissue, it will be immediately visible upon incision. In cases where the hernia sac is interstitial, the incision may need to be extended into the external oblique muscle to adequately access the sac. The surgeon then carefully dissects the hernia sac from the surrounding tissue down to its neck, ensuring that the contents of the sac are inspected. If the bowel appears healthy, it is returned to the abdominal cavity. Any adhesions that may be present are severed, and the hernia sac is either excised or inverted. Finally, the defects in the fascia of the transversus abdominis and internal oblique muscles are closed, followed by the closure of the external oblique muscle incision. This procedure is essential for preventing complications associated with hernias, such as incarceration or strangulation of the bowel.

1. Indications

The repair of a spigelian hernia is indicated for patients presenting with the following conditions:

Protrusion of abdominal contents through the semilunar line, leading to a visible or palpable hernia.
Symptoms of discomfort or pain in the lower abdomen, which may be exacerbated by physical activity or straining.
Risk of incarceration or strangulation of the hernia, which can lead to serious complications if not addressed.
Cosmetic concerns related to the appearance of the hernia, prompting the patient to seek surgical intervention.

2. Procedure

The procedure for repairing a spigelian hernia involves several critical steps to ensure successful correction of the hernia.

Step 1: Incision A skin incision is made directly over the hernia defect. This incision allows access to the hernia sac. If the hernia sac is located within the subcutaneous tissue, it will be immediately visible upon incision. In cases where the hernia sac is interstitial, the incision may need to be extended into the external oblique muscle to adequately access the sac.
Step 2: Dissection The hernia sac is carefully dissected free from the surrounding tissue down to the neck of the sac. This step is crucial to ensure that the sac can be properly managed without damaging surrounding structures.
Step 3: Inspection of Contents Once the sac is isolated, it is opened to inspect the contents. This inspection is vital to determine the health of the bowel and any other structures within the sac.
Step 4: Management of Contents If the bowel appears healthy, it is gently returned to the abdominal cavity. If any adhesions are present, they are carefully severed to free the bowel and other contents.
Step 5: Sac Management The hernia sac is either excised or inverted, depending on the surgical approach and the condition of the sac.
Step 6: Closure of Defects The defects in the fascia of the transversus abdominis muscle and the internal oblique muscle are closed to restore the integrity of the abdominal wall.
Step 7: Closure of Incision Finally, the incision made in the external oblique muscle is closed, completing the surgical repair of the spigelian hernia.

3. Post-Procedure

Post-procedure care following a spigelian hernia repair typically includes monitoring for any signs of complications, such as infection or recurrence of the hernia. Patients are often advised to limit physical activity for a specified period to allow for proper healing. Pain management may be necessary, and follow-up appointments are scheduled to assess recovery and ensure that the surgical site is healing appropriately. Patients should be educated on signs of complications, such as increased pain, swelling, or changes in bowel habits, and instructed to seek medical attention if these occur.

Short Descr	REPAIR SPIGELIAN HERNIA
Medium Descr	RPR SPIGELIAN HERNIA
Long Descr	Repair spigelian hernia
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)	1 - 150% payment adjustment for bilateral procedures applies.
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
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	86 - Other hernia repair