45120 Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with pull-through procedure and anastomosis (eg, Swenson, Duhamel, or Soave type operation)

Name of the Procedure:

Proctectomy, complete for congenital megacolon with an abdominal and perineal approach; including pull-through procedure and anastomosis (examples include Swenson, Duhamel, or Soave type operations).

Summary

A complete proctectomy with pull-through and anastomosis is a surgical procedure to remove part of the colon and rectum affected by congenital megacolon (Hirschsprung's disease) and to reconnect the remaining healthy bowel to the anus.

Purpose

The procedure addresses congenital megacolon, a condition where parts of the colon lack nerve cells, leading to persistent constipation and bowel obstruction. The goal is to remove the non-functional segment and restore normal bowel function.

Indications

• Chronic severe constipation not relieved by other treatments.
• Symptoms like abdominal distention, vomiting, and failure to thrive in infants.
• Diagnostic confirmation of Hirschsprung's disease through biopsy showing absence of ganglion cells in the bowel wall.

Preparation

• The patient may need to fast for several hours before surgery.
• Bowel preparation to clean out intestines may be required.
• Pre-operative diagnostic tests, including imaging studies and rectal biopsies.
• Discussion of medical history and medication adjustments.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: An abdominal incision is made to access the colon and rectum.
3. Mobilization: The diseased segment of colon and rectum is carefully separated and mobilized.
4. Resection: The affected portion of the colon and rectum is removed.
5. Pull-through Procedure: The remaining healthy bowel is "pulled through" and connected to the anus.
6. Anastomosis: The ends of the bowel are surgically joined together (anastomosis) using techniques such as the Swenson, Duhamel, or Soave methods.
7. Closure: Incisions are closed, and the area is cleaned and dressed.

Duration

The procedure typically takes about 3-6 hours, depending on complexity.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Pediatric or colorectal surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Anastomotic leak (where the bowel connection fails)
• Strictures or narrowing at the site of anastomosis
• Long-term bowel dysfunction or incontinence

Benefits

• Relief from symptoms of chronic constipation and bowel obstruction.
• Improved bowel function and quality of life.
• Prevention of severe complications like enterocolitis and bowel dilation.

Recovery

• Hospital stay of 5-7 days post-surgery.
• Gradual return to normal diet and activity over several weeks.
• Pain management with medications.
• Follow-up appointments to monitor bowel function and healing.
• Possible dietary adjustments and bowel management strategies in the long term.

Alternatives

• Less invasive medical management (e.g., laxatives, enemas) is typically ineffective for this condition.
• Other surgical techniques or staged procedures might be considered in specific cases.

Patient Experience

• The patient will be under general anesthesia and won't feel anything during surgery.
• Post-operative pain and discomfort, managed with medications.
• Initial dietary restrictions and gradual reintroduction of solid foods.
• Regular follow-up and monitoring for any signs of complications or problems.

This markdown provides a thorough description of the proctectomy procedure using layman's terms and offers a comprehensive overview suitable for patient education or informational purposes.