44615 Intestinal stricturoplasty (enterotomy and enterorrhaphy) with or without dilation, for intestinal obstruction

Name of the Procedure:

Intestinal Stricturoplasty (Enterotomy and Enterorrhaphy) with or without Dilation for Intestinal Obstruction

Summary

Intestinal stricturoplasty is a surgical procedure used to treat narrow sections (strictures) in the intestines. It involves cutting the strictured area and sewing it back together to widen the passage without removing any part of the intestine. This can be done with or without dilation, which uses a balloon to help open the narrow section.

Purpose

The purpose of intestinal stricturoplasty is to alleviate symptoms caused by intestinal obstructions due to strictures. The primary goal is to restore normal passage of food and waste through the intestines, thereby improving digestion and preventing complications such as severe blockages.

Indications

• Symptoms of intestinal obstruction such as severe abdominal pain, bloating, nausea, vomiting, and inability to pass stool or gas.
• Diagnosed strictures due to conditions like Crohn's disease, previous surgeries, or radiation therapy.
• Patients who have multiple strictures or recurrent obstructions not amenable to other treatments.

Preparation

• Patients are typically instructed to fast for a specified period (often 8-12 hours) before the procedure.
• Medication adjustments may be necessary, particularly anticoagulants or antiplatelet drugs.
• Diagnostic tests such as imaging studies (CT scan, MRI, or X-rays) and endoscopy may be performed to assess the location and severity of the strictures.

Procedure Description

1. The patient is placed under general anesthesia.
2. A surgical incision is made in the abdomen to access the intestines.
3. The surgeon identifies the strictured area(s) and performs an enterotomy (cutting into the intestine).
4. The intestine is then widened, and the incision is closed using enterorrhaphy (suturing the intestine together).
5. If dilation is used, a balloon may be inserted and inflated to further open the strictured area.
6. The abdomen is then closed, and the patient is moved to recovery.

Duration

The procedure typically takes between 1-3 hours, depending on the number and complexity of strictures.

Setting

Intestinal stricturoplasty is performed in a hospital operating room.

Personnel

• General or gastrointestinal surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hemorrhage
• Anesthesia-related risks
• Leak at the site of suturing (anastomotic leak)
• Stricture reformation
• Bowel perforation

Benefits

• Relief from symptoms of intestinal obstruction.
• Preservation of the intestine length, which is beneficial in patients with multiple strictures.
• Improved quality of life and digestion.

Recovery

• Hospital stay of 3-7 days post-procedure.
• Gradual reintroduction of a regular diet.
• Pain management with prescribed medications.
• Follow-up appointments to monitor healing and ensure the absence of complications.
• Full recovery typically takes several weeks, though patients may resume normal activities progressively.

Alternatives

• Endoscopic dilation without surgery, which is less invasive but may not be as effective for severe or multiple strictures.
• Intestinal resection, which involves removing the strictured section of the intestine but can result in shorter bowel and potential complications like short bowel syndrome.
• Medication management, which is less effective for mechanical obstructions but can be used for milder symptoms.

Patient Experience

Patients will be under general anesthesia during the procedure and will not feel pain. Post-procedure, they may experience pain and discomfort around the surgical site, managed with painkillers. Initial dietary restrictions are common, and patients can expect a gradual return to normal activities over a few weeks. Regular follow-up is critical for monitoring and managing any complications.