Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop ileostomy, and rectal mucosectomy, when performed
CPT4 code
Name of the Procedure:
Total Abdominal Colectomy with Proctectomy and Ileoanal Anastomosis; Creation of an Ileal Reservoir (S or J), including Loop Ileostomy and Rectal Mucosectomy.
Summary
Total abdominal colectomy with proctectomy and ileoanal anastomosis is a surgical procedure where the colon and rectum are removed, and a new rectum is created using a portion of the small intestine. This new rectum is then connected to the anus. The procedure also involves creating a temporary ileostomy, where a loop of the small intestine is brought out to the surface of the abdomen to allow waste to leave the body during recovery.
Purpose
This procedure is used to treat patients with diseases affecting the entire colon and rectum, such as ulcerative colitis or familial adenomatous polyposis. The goal is to remove diseased tissue, alleviate symptoms, and restore intestinal function by creating a new rectal reservoir from the small intestine.
Indications
- Chronic ulcerative colitis unresponsive to medical treatment
- Familial adenomatous polyposis (FAP)
- Certain cases of colorectal cancer
- Severe cases of Crohn's disease affecting the colon and rectum
Preparation
- Preoperative fasting (usually from midnight before surgery)
- Bowel preparation to clean the intestines
- Adjustments to medications as per doctor's advice
- Pre-surgery blood tests, imaging studies, and overall health assessments
Procedure Description
- Anesthesia: The patient is put under general anesthesia.
- Abdominal Incision: An incision is made in the abdomen to access the colon.
- Removal of Colon and Rectum: The colon and rectum are carefully removed.
- Creation of Ileal Reservoir: A portion of the small intestine is fashioned into a J or S-shaped pouch, creating a new rectal reservoir.
- Ileoanal Anastomosis: The newly created reservoir is connected to the anus.
- Loop Ileostomy Creation: A loop of the small intestine is brought out to the skin surface to form a temporary stoma for waste elimination.
- Rectal Mucosectomy: When necessary, the lining of the rectal stump is removed.
Duration
The procedure typically takes between 3 to 6 hours, depending on the specifics of each case.
Setting
This surgery is performed in a hospital operating room.
Personnel
- General Surgeon or Colorectal Surgeon
- Anesthesiologist
- Surgical Nurses
- Operating Room Technicians
Risks and Complications
- Infection
- Bleeding
- Anastomotic leakage (leak from the surgical join)
- Small bowel obstruction
- Pouch complications (e.g., pouchitis)
- Final stoma creation (in case complications prevent ileostomy reversal)
- Some patients might need permanent ileostomy if complications arise
Benefits
- Alleviation of symptoms caused by ulcerative colitis, FAP, or colorectal cancer
- Removal of diseased or precancerous tissue
- Potential for a more normal bowel function after recovery, avoiding permanent ileostomy
Recovery
- Hospital stay of 5-10 days is common.
- Gradual dietary progression from liquids to solids.
- Pain management with prescribed medications.
- Follow-up visits to monitor healing and plan for ileostomy closure.
- Full recovery and adjustment might take several months, with temporary restrictions on strenuous activities.
Alternatives
- Medical management with anti-inflammatory or immunosuppressive drugs (for ulcerative colitis or Crohn's disease)
- Segmental colectomy or subtotal colectomy (removing only part of the colon)
- Permanent ileostomy without creation of an ileal reservoir
Patient Experience
- The patient will be under general anesthesia and will not feel anything during the procedure.
- Postoperative pain and discomfort are managed with medication.
- Temporary changes in bowel habits and adaptation to the ileostomy.
- Emotional and physical support, including guidance from stoma care nurses, is crucial for recovery.