44141 Colectomy, partial; with skin level cecostomy or colostomy

Name of the Procedure:

Partial Colectomy with Skin Level Cecostomy or Colostomy

Summary

A partial colectomy with skin level cecostomy or colostomy is a surgical procedure where a portion of the colon is removed, and an opening (stoma) is created on the abdominal wall to allow waste to leave the body. This can be temporary or permanent depending on the underlying condition.

Purpose

The procedure addresses conditions like colorectal cancer, diverticulitis, inflammatory bowel disease, or traumatic injury to the colon. The goal is to remove the diseased or damaged section of the colon and create an alternative pathway for waste expulsion to alleviate symptoms and improve the patient’s quality of life.

Indications

• Chronic or severe diverticulitis
• Colorectal cancer
• Severe inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis)
• Intestinal blockage or perforation
• Traumatic injury to the colon
• Refractory constipation or bowel dysfunction

Preparation

• Preoperative fasting (typically from midnight before the surgery)
• Bowel preparation (laxatives, enemas)
• Adjustments to current medications as advised by the healthcare provider
• Diagnostic tests like blood work, colonoscopy, or imaging studies (CT scan, MRI)

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A surgical incision is made in the abdomen, either open (large incision) or laparoscopic (small incisions).
3. Colon Resection: The diseased or damaged portion of the colon is identified and removed.
4. Stoma Creation: An opening (stoma) is created in the abdominal wall, and the end of the remaining colon or cecum is brought through this opening.
5. Stoma Securing: The stoma is secured to the skin, forming a cecostomy (if the cecum is used) or colostomy.
6. Closure: The incisions are closed with sutures or staples.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and method used (open vs. laparoscopic).

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon (typically a colorectal or general surgeon)
• Anesthesiologist
• Surgical nurses
• Possibly a surgical resident or fellow

Risks and Complications

• Infection
• Bleeding
• Anesthesia-related complications
• Injury to surrounding organs
• Stoma complications (prolapse, retraction, obstruction)
• Long-term risks: Hernia, bowel obstruction, stoma-related skin irritation

Benefits

• Relief from symptoms related to the diseased or damaged colon
• Removal of cancerous growths
• Improved bowel function
• Reduced risk of future complications related to the original condition

Recovery

• Hospital stay: Several days to a week
• Pain management: Medications for pain relief
• Gradual return to normal diet
• Wound care and stoma management education
• Follow-up appointments for suture removal and recovery monitoring
• Expected full recovery: Several weeks to a few months, with some adjustments required for living with a stoma

Alternatives

• Medical management (medications, lifestyle changes) for less severe conditions
• Other surgical options like total colectomy or bowel resection without stoma creation
• Minimally invasive procedures for specific conditions

Patient Experience

Patients may feel discomfort and pain post-surgery, managed with medication. Emotional support is crucial as adjusting to a stoma can be challenging. Gradual improvements in symptoms should be noticeable as recovery progresses. Pain management, wound care, and regular follow-up appointments are essential for a smooth recovery.