Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy
CPT4 code
Name of the Procedure:
Laparoscopy, Surgical; Colectomy, Partial, with Removal of Terminal Ileum with Ileocolostomy
Common Name: Laparoscopic Partial Colectomy with Ileocolostomy
Summary
This is a minimally invasive surgical procedure where a portion of the colon (large intestine) and the terminal ileum (end of the small intestine) are removed. The remaining sections are then connected, forming an ileocolostomy, to restore bowel continuity.
Purpose
This procedure addresses conditions like Crohn's disease, cancer, severe diverticulitis, and other diseases affecting both the colon and the terminal ileum. The goal is to remove the diseased portion of the intestines, alleviate symptoms, and restore normal bowel function.
Indications
- Chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis)
- Colon cancer that involves the terminal ileum
- Severe or recurrent diverticulitis
- Intestinal obstructions or perforations
- Symptoms include chronic abdominal pain, bowel obstruction, severe diarrhea, and weight loss.
Preparation
- Patients are usually required to fast for at least 8 hours before the procedure.
- Bowel preparation (cleansing the intestines) is often necessary.
- Adjustments to medications, especially blood thinners or anti-inflammatory drugs, may be required.
- Pre-operative diagnostic tests might include colonoscopy, blood tests, and imaging studies (CT scan or MRI).
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incisions and Access: Small incisions are made in the abdomen to insert a laparoscope (a tiny camera) and surgical instruments.
- Resection: The surgeon identifies the diseased sections of the colon and terminal ileum, carefully excises them, and removes them through the incisions.
- Ileocolostomy: The ends of the remaining ileum and colon are reconnected to restore intestinal continuity.
- Closure: The incisions are closed with sutures or staples.
Duration
The procedure typically takes 2 to 4 hours.
Setting
The procedure is performed in a hospital operating room.
Personnel
- General or colorectal surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Injury to surrounding organs
- Anastomotic leak (leakage at the connection site)
- Bowel obstruction due to scar tissue
- General risks of anesthesia
- Long-term changes in bowel habits
Benefits
- Relief from symptoms like abdominal pain, diarrhea, and obstruction.
- Removal of diseased or cancerous tissue.
- Potential improvement in quality of life. Benefits are generally realized within weeks to months post-surgery.
Recovery
- Patients may stay in the hospital for 5 to 7 days.
- Gradual reintroduction of diet, starting with liquids.
- Avoid heavy lifting and strenuous activities for several weeks.
- Follow-up appointments to monitor healing and bowel function.
- Pain management with prescribed medications and activity modifications.
Alternatives
- Medical management with medications for inflammatory conditions.
- Less invasive procedures like endoscopic treatments (depending on the case).
- Stoma formation (creating an external opening for intestine drainage).
Pros and Cons of Alternatives:
Medical Management: Less invasive but may not be effective for severe cases.
Endoscopic Treatments: Less invasive, but limited to certain cases and not effective for extensive disease.
Stoma Formation: Effective in severe cases but involves a significant lifestyle change.
Patient Experience
- During: Patients will be under general anesthesia and won’t feel anything during the procedure.
- After: Post-operative pain managed with medications, initial discomfort, and swelling. Gradual improvement in symptoms over several weeks.
- Pain Management: Pain is controlled with prescribed analgesics and supportive care practices.
Patients should communicate any unusual symptoms or severe pain to their healthcare team promptly.