44188 Laparoscopy, surgical, colostomy or skin level cecostomy

Name of the Procedure:

Laparoscopy, surgical, colostomy or skin level cecostomy

Summary

Laparoscopy for colostomy or cecostomy is a minimally invasive surgical procedure in which a surgeon makes small incisions in the abdomen to create an opening (stoma) in the colon or cecum, which allows bodily waste to exit through the abdomen into an external pouch.

Purpose

This procedure addresses severe intestinal conditions such as bowel obstruction, infections, cancer, or injury. The goals are to divert stool from a diseased or damaged part of the colon, reduce symptoms, and improve the patient's quality of life.

Indications

• Severe colorectal diseases such as cancer
• Intestinal obstruction
• Chronic inflammatory conditions like Crohn's disease or ulcerative colitis
• Traumatic injury to the colon
• Infections requiring bowel diversion

Preparation

• Patients are typically advised to fast for at least 8 hours before the procedure.
• They may need to stop certain medications (anticoagulants, antiplatelets) after consulting their doctor.
• Pre-procedure tests include blood work, imaging studies like CT scans, and bowel preparation with laxatives or enemas.

Procedure Description

1. The patient is given general anesthesia.
2. Small incisions are made in the abdomen.
3. A laparoscope (a thin tube with a camera) is inserted to visualize the abdominal organs.
4. Surgical instruments are inserted through other small incisions to manipulate the organs.
5. A section of the colon or cecum is pulled through an incision to create a stoma.
6. The stoma is secured to the skin, and an external pouch is attached to collect waste.
7. Incisions are closed with stitches or surgical adhesive.

Duration

The procedure typically takes between 1 to 3 hours depending on the complexity.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Bleeding
• Hernia around the stoma
• Bowel obstruction
• Stoma complications (e.g., prolapse, skin irritation)
• Rare risks include injury to surrounding organs

Benefits

• Relief from symptoms of bowel disease
• Improved bowel function
• Enhanced quality of life
• Quick recovery due to minimally invasive technique

Recovery

• Patients typically stay in the hospital for 2-5 days after the procedure.
• They may experience some pain and will be given pain management options.
• Stoma care and management education will be provided.
• Full recovery can take several weeks; physical activity may be restricted during this time.

Alternatives

• Open surgery for colostomy or cecostomy, which involves larger incisions and a longer recovery time.
• Non-surgical management options like medication and dietary changes, though these may be less effective for severe conditions.

Patient Experience

During the procedure, the patient will be under general anesthesia and unaware of the surgery. After the procedure, patients may feel discomfort at the incision sites and some abdominal pain, which are managed with prescribed medications. Stoma care will require learning and adjustment but thorough education and support will be provided.