45395 Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy

Name of the Procedure:

Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy
Common name(s): Laparoscopic abdominoperineal resection with colostomy, APR with colostomy

Summary

In this procedure, a surgeon uses minimally invasive techniques to remove the rectum and anus, and creates a colostomy to allow waste to exit the body through an opening in the abdomen.

Purpose

The procedure is typically performed to treat rectal cancer or other severe rectal diseases. The goals are to remove diseased tissue, prevent the spread of cancer, and restore bowel function through a colostomy.

Indications

• Diagnosis of rectal cancer
• Severe inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis)
• Rectal trauma
• Benign but problematic rectal tumors or polyps Patients are considered appropriate for this procedure if they have not responded to other treatments and have good overall health to tolerate surgery.

Preparation

• Fasting for at least 8 hours before the procedure
• Bowel preparation involving laxatives or enemas
• Stop certain medications as instructed by the physician (e.g., blood thinners)
• Preoperative diagnostic testing such as blood work, imaging studies, and colonoscopy

Procedure Description

1. The patient is placed under general anesthesia.
2. Small incisions are made in the abdomen to insert laparoscopic instruments and a camera.
3. The surgeon detaches the rectum and anus from surrounding tissues.
4. The rectum and anus are removed through an incision near the anus.
5. A colostomy, an opening in the abdominal wall, is created to allow stool to pass into an external bag.
6. The incisions are closed with sutures or staples.

Duration

Typically, the procedure takes 2 to 4 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeons specialized in colorectal surgery
• Anesthesiologists
• Operating room nurses
• Surgical technologists

Risks and Complications

Common risks:

• Infection
• Bleeding
• Blood clots (DVT)
• Reaction to anesthesia Rare but severe risks:
• Injury to surrounding organs (e.g., bladder, ureter)
• Anastomotic leak
• Stoma complications (e.g., blockage, retraction) Management includes medications, wound care, or additional surgery if necessary.

Benefits

The procedure aims to remove diseased tissue, which can alleviate symptoms, prevent disease progression, and improve quality of life. Benefits can be realized immediately in terms of symptom relief, though complete recovery may take some time.

Recovery

• Hospital stay of 5 to 7 days
• Postoperative pain management using medication
• Instructions for colostomy care and lifestyle adjustments
• Avoid heavy lifting and strenuous activities for several weeks
• Follow-up appointments for monitoring recovery

Alternatives

• Non-surgical treatments like radiation therapy or chemotherapy, primarily for cancer
• Less extensive surgical options, including partial resection or local excision
• Risks and benefits depend on the patient's specific condition

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-surgery, the patient might experience pain, managed with pain relief medications. Learning to manage a colostomy initially requires time and education but is typically supported with resources provided by healthcare professionals.