44160 Colectomy, partial, with removal of terminal ileum with ileocolostomy

Name of the Procedure:

Colectomy, Partial with Removal of Terminal Ileum and Ileocolostomy
Common names: Partial Colectomy, Bowel Resection with Ileocolostomy

Summary

A partial colectomy with removal of the terminal ileum is a surgical procedure where part of the colon and the end section of the small intestine (ileum) are removed. The remaining sections of the small intestine and colon are then joined together in a procedure called an ileocolostomy to ensure the continuity of the digestive tract.

Purpose

This surgery is used to treat conditions such as Crohn's disease, cancer, severe inflammation, bowel obstruction, or other diseases affecting the terminal ileum and/or colon. The goal is to remove the diseased portion of the bowel to alleviate symptoms, prevent complications, and improve the patient’s quality of life.

Indications

• Chronic inflammation (e.g., Crohn's disease)
• Colon cancer involving the terminal ileum
• Severe bleeding from the bowel
• Bowel obstruction
• Diverticulitis with complications

Preparation

• The patient will generally need to fast for at least 8 hours before the procedure.
• A bowel prep may be required to clean out the intestines.
• Medications may need to be adjusted, including stopping blood thinners.
• Preoperative assessments may include blood tests, imaging studies, and a physical exam.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdomen to access the intestines; alternatively, the procedure may be done laparoscopically with smaller incisions and a camera.
3. The surgeon locates and removes the diseased portion of the colon and the terminal ileum.
4. The remaining ends of the small intestine and the colon are joined together using sutures or staples in an anastomosis, forming an ileocolostomy.
5. The abdominal incision(s) are closed.

Tools Used: Scalpel, laparoscopic equipment (if applicable), sutures/staples.

Anesthesia: General anesthesia is administered to keep the patient unconscious and pain-free.

Duration

The procedure typically takes between 2 to 4 hours, depending on the specifics of the case and the surgical approach used.

Setting

The procedure is usually performed in a hospital operating room.

Personnel

• Primary Surgeon
• Surgical Assistant(s)
• Anesthesiologist
• Surgical Nurses
• Possibly a gastrointestinal specialist

Risks and Complications

• Infection at the surgical site
• Bleeding
• Leakage at the anastomosis site
• Bowel obstruction
• Damage to surrounding organs
• Complications related to anesthesia
• Long-term issues, such as changes in bowel habits

Benefits

• Relief from symptoms of the underlying condition (e.g., pain, bleeding, obstruction)
• Prevention of further complications or progression of disease
• Improved quality of life

These benefits may become noticeable within several weeks after the surgery, as the patient recovers.

Recovery

• Hospital stay of about 3 to 7 days.
• Pain management often includes oral or IV medications.
• Gradual reintroduction to eating and drinking, starting with liquids.
• Instructions on wound care and signs of infection.
• Restrictions on heavy lifting and strenuous activity for several weeks.
• Follow-up appointments to monitor recovery and manage any complications.

Alternatives

• Medical management (e.g., medications, dietary changes) for less severe cases.
• Endoscopic procedures for certain specific issues.
• Other surgical options like total colectomy, depending on the extent of the disease.

Pros and Cons of Alternatives: Medical management can avoid surgery but might not be effective for advanced disease. Endoscopic procedures are less invasive but may not be suitable for all conditions.

Patient Experience

During the procedure, the patient will be under general anesthesia and feel no pain. After the procedure, patients may experience some discomfort and pain, which can be managed with medications. Initial recovery will involve some dietary restrictions and fatigue, with a gradual return to normal activities over a few weeks.