Laparoscopic repair of abdominal aortic aneurysm

NICE interventional procedures guidance [IPG229] Published date:

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The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laparoscopic repair of abdominal aortic aneurysm in August 2007. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

The guidance was considered for reassessment in August 2010 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.

  • Description

    A midline minilaparotomy incision is made for insertion of one of the surgeon's hands for hand assisted laparoscopic surgery (HALS). Three or more small skin incisions are made for insertion of a laparoscope and instruments. Clamps are applied above and below the aneurysm and its sac is opened. Thrombus is removed and patent lumbar arteries are sutured from the inside of the aneurysm. A prosthetic vascular graft is anastomosed to the proximal and distal ends of the aorta. The aneurysm wall and the posterior parietal peritoneum are closed to cover the graft.

  • OPCS4.6 Code(s)

    A code from categories L18.- or L19.- would be selected depending if the procedure is an emergency (an emergency is defined as using unscheduled operating theatre time) or not (or not known) and with the fourth character dependent on the specific site of the aorta that is replaced:

    L18.- Emergency replacement of aneurysmal segment of aorta

    Includes: Emergency replacement of aneurysmal segment of aorta using prosthesis

    Y75.4 Hand assisted minimal access approach to abdominal cavity or Y75.2 Laparoscopic approach to abdominal cavity NEC (see Note)

    or

    L19.- Other replacement of aneurysmal segment of aorta

    Includes: Replacement of aneurysmal segment of aorta using prosthesis NEC

    Y75.4 Hand assisted minimal access approach to abdominal cavity or Y75.2 Laparoscopic approach to abdominal cavity NEC (see Note)

    Note: : Laparoscopic repair of abdominal aortic aneurysm can be done by hand-assisted laparoscopic surgery (HALS) coded by the addition of  Y75.4 Hand assisted minimal access approach to abdominal cavity or by the technically more demanding totally laparoscopic surgery (TLS ) coded by the addition of Y75.2 Laparoscopic approach to abdominal cavity NEC.

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding

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