45550 Proctopexy (eg, for prolapse); with sigmoid resection, abdominal approach

Name of the Procedure:

Proctopexy (for prolapse) with sigmoid resection, abdominal approach

Summary

Proctopexy with sigmoid resection is a surgical procedure performed through an abdominal incision to correct a prolapsed rectum. The surgery involves removing a portion of the sigmoid colon and securing the rectum to the surrounding tissues to prevent further prolapse.

Purpose

This procedure addresses rectal prolapse, a condition where the rectum slips out of its normal position. The goal is to restore normal anatomy, relieve symptoms like pain and discomfort, and prevent recurrence of prolapse.

Indications

• Symptoms like visible bulging of the rectum outside the anus, fecal incontinence, constipation, or pain.
• Diagnosis of full-thickness rectal prolapse confirmed through medical imaging or physical examination.
• Failure of conservative treatments such as dietary changes, pelvic floor exercises, or medications.

Preparation

• Patients are usually instructed to fast for at least 8 hours before the surgery.
• Possible adjustments to medications, particularly blood thinners, as guided by the healthcare provider.
• Preoperative tests may include blood work, colonoscopy, or imaging studies such as MRI or CT scans to assess the extent of prolapse.

Procedure Description

1. Anesthesia is administered to ensure the patient is asleep and pain-free.
2. An abdominal incision is made to access the sigmoid colon and rectum.
3. The prolapsed segment of the sigmoid colon is identified and resected (removed).
4. The rectum is then reattached and fixed (pexy) to the sacrum or other pelvic structures.
5. The surgical site is closed, and postoperative dressings are applied.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the case.

Setting

The surgery is performed in a hospital operating room.

Personnel

• A colorectal surgeon or general surgeon with expertise in abdominal surgeries.
• An anesthesiologist to administer and monitor anesthesia.
• Surgical nurses and assistants to provide perioperative care and support.

Risks and Complications

• Common risks include bleeding, infection, and reaction to anesthesia.
• Rare complications may include injury to nearby organs, bowel obstruction, or recurrence of prolapse.
• Postoperative management of complications may involve medications, additional surgeries, or specific interventions.

Benefits

• Restoration of normal rectal anatomy.
• Relief from symptoms like discomfort, incontinence, and constipation.
• Improved quality of life.

Recovery

• Patients may stay in the hospital for 3 to 7 days post-procedure.
• Instructions may include wound care, pain management, and activity limitations.
• Full recovery typically takes 4 to 6 weeks, with follow-up appointments to monitor healing.

Alternatives

• Conservative treatments, such as stool softeners, diet changes, and pelvic floor exercises.
• Minimally invasive surgical options, like laparoscopic rectopexy, with various pros and cons compared to open surgery.
• Each alternative has specific indications and success rates based on the individual patient's condition.

Patient Experience

• During the procedure, patients are under general anesthesia and feel no pain.
• Postoperative discomfort is managed with pain medications.
• Patients may experience soreness, fatigue, and limited mobility initially, improving gradually over the recovery period.