Revision of ileostomy; complicated (reconstruction in-depth) (separate procedure)
CPT4 code
Name of the Procedure:
Revision of Ileostomy; Complicated (Reconstruction In-Depth)
Common name: Complicated Ileostomy Revision
Summary
A complicated revision of ileostomy is a surgical procedure to reconstruct or correct an ileostomy, which is a surgically created opening in the abdominal wall for waste elimination. This revision is more intricate than a standard revision and addresses complex issues.
Purpose
This procedure is performed to correct complications or issues arising from a previous ileostomy, such as blockages, leaks, prolapse, or severe skin irritation. The goal is to restore proper function, alleviate symptoms, and improve the patient’s quality of life.
Indications
- Persistent or recurrent blockage of the stoma.
- Stomal prolapse or retraction.
- Severe skin irritation or infection around the stoma.
- Leakage or poor fitting of the stoma appliance.
- Hernia around the stoma site. Candidates typically include patients experiencing these complications who have not found relief through non-surgical treatments.
Preparation
- Patients may need to fast for a specified period before surgery.
- Adjustments to certain medications (e.g., blood thinners) will be necessary.
Preoperative assessments, such as blood tests, imaging studies, and possibly a review by a stoma care nurse.
Procedure Description
- Anesthesia: The patient is administered general anesthesia.
- Incision: The surgeon makes an incision around the existing stoma.
- Inspection/Correction: The problematic ileostomy is carefully inspected. Any scar tissue, blockages, or complications are addressed. The bowel is repositioned as necessary.
- Reconstruction: The surgeon reconstructs the ileostomy to ensure a good fit for the stoma appliance and proper bowel function.
- Closure: The incision is closed with sutures or staples. Tools/Equipment: Surgical scalpel, retractors, sutures, staplers, and other standard surgical equipment.
Duration
The procedure typically takes 2 to 4 hours, depending on the complexity.
Setting
The surgery is performed in a hospital operating room.
Personnel
- Surgeons (specializing in colorectal surgery)
- Anesthesiologists
- Operating Room Nurses
- Surgical Assistants
Risks and Complications
- Infection
- Bleeding
- Damage to surrounding organs
- Stoma complications such as retraction or hernia recurrence
- Risks associated with general anesthesia These complications are managed with antibiotics, additional surgeries, or supportive care as necessary.
Benefits
- Restoration of proper ileostomy function
- Alleviation of symptoms like pain, leakage, or irritation
- Improved quality of life Benefits may become apparent within weeks following recovery.
Recovery
- Hospital stay of a few days to monitor recovery.
- Instructions include care for the stoma, managing pain with prescribed medications, and limiting physical activity.
- Follow-up appointments with the surgeon and stoma care nurse. Full recovery usually occurs within 4 to 6 weeks.
Alternatives
- Non-surgical management (stoma appliances, dietary changes)
- Less invasive surgical interventions, if applicable
- Reversal of the ileostomy, if possible Pros and Cons: Non-surgical options may not fully resolve issues, whereas reversal is only applicable in select cases.
Patient Experience
During the procedure, the patient will be under general anesthesia and feel no pain. Post-surgery, there may be discomfort, pain at the incision site, and initial difficulty in managing the new stoma, which will improve over time with proper care and pain management strategies.