49324 Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter

Name of the Procedure:

Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter

Summary

In this procedure, a surgeon uses a special camera called a laparoscope to look inside the abdomen and insert a catheter. The catheter is tunneled under the skin and into the abdomen, allowing for long-term drainage or administration of fluids.

Purpose

This procedure is often used to manage fluid buildup (ascites) in the abdomen, which can occur due to liver disease, cancer, or other medical conditions. It can also be used for chemotherapy treatment or peritoneal dialysis.

Indications

• Persistent abdominal fluid retention (ascites)
• Need for peritoneal dialysis
• Administration of intraperitoneal medication, such as chemotherapy
• Patients with chronic liver disease or certain cancers

Preparation

• Patients may be instructed to fast for a certain period before the procedure (typically 8-12 hours).
• Adjustment or temporary discontinuation of certain medications may be advised.
• Pre-procedure tests may include blood work, imaging studies, and a physical examination.

Procedure Description

1. The patient is placed under general anesthesia.
2. Small incisions are made in the abdomen.
3. A laparoscope, which is a thin tube with a camera, is inserted to provide a view inside the abdomen.
4. The surgeon creates a tunnel under the skin to guide the catheter into the abdominal cavity.
5. The catheter is carefully positioned, and its placement is confirmed.
6. The incisions are closed with sutures or surgical glue.
7. The external end of the catheter is secured and covered with a sterile dressing.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

This procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• General surgeon or a specialist surgeon
• Anesthesiologist
• Surgical nurses and technologists

Risks and Complications

• Infection
• Bleeding
• Injury to internal organs
• Blockage or displacement of the catheter
• Reaction to anesthesia
• Rarely, a need for additional surgery

Benefits

• Relief from abdominal pain and discomfort caused by fluid buildup
• Improved breathing and mobility
• Enhanced quality of life
• Allows for long-term peritoneal dialysis or targeted chemotherapy

Recovery

• Patients may need to stay in the hospital for observation for one to several days.
• Post-procedure instructions may include pain management, wound care, and activity restrictions.
• Avoiding strenuous activities for a few weeks.
• Follow-up appointments to monitor catheter function and manage any complications.

Alternatives

• Repeated paracentesis (needle drainage of abdominal fluid)
• Medical management with diuretics (water pills)
• Other forms of dialysis or systemic chemotherapy

Patient Experience

• During the procedure, the patient is asleep under general anesthesia.
• Post-procedure, patients may feel some discomfort or pain at the incision sites.
• Pain can usually be managed with prescribed medications.
• Patients may experience temporary restrictions on activities and need to follow care instructions closely to prevent complications.