Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)
CPT4 code
Name of the Procedure:
Laparoscopy, Surgical; Colectomy, Partial, with End Colostomy and Closure of Distal Segment
Commonly known as: Hartmann's Procedure (Laparoscopic Partial Colectomy with Colostomy)
Summary
In layman's terms, this procedure involves the surgical removal of a portion of the colon via small incisions and laparoscopic tools. The procedure ends with the creation of a colostomy (an opening of the colon to the outside of the body) and the closure of the leftover part of the bowel.
Purpose
This procedure addresses conditions like colon cancer, diverticulitis, or severe bowel obstruction. The goal is to remove the diseased or damaged part of the colon, relieve symptoms, and prevent further complications.
Indications
- Severe diverticulitis not responding to medical treatment
- Colon cancer
- Serious bowel obstructions
- Traumatic injury to the colon
- Infection or abscess in the colon Criteria include failed conservative treatments, recurrent symptoms, and overall patient health warranting surgery.
Preparation
- Fasting for at least 8 hours prior to surgery
- Cessation of certain medications as directed
- Pre-operative bowel preparation to clean the intestines
- Blood tests, imaging studies (e.g., CT scan), and possibly an EKG
- Consultation with an anesthesiologist
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incisions: Small incisions are made in the abdominal wall.
- Laparoscopic Tools: A laparoscope (camera) and surgical tools are inserted through the incisions.
- Colon Removal: The affected section of the colon is located and removed.
- End Colostomy: The end of the remaining colon is brought through an opening in the abdominal wall to form a stoma.
- Closure of Distal Segment: The remaining part of the colon is closed internally. The laparoscope provides visual guidance throughout the procedure.
Duration
The procedure typically takes 2 to 4 hours, depending on complexity.
Setting
Performed in a hospital operating room.
Personnel
- Surgeons (typically a colorectal or general surgeon)
- Surgical nurses
- Anesthesiologist
- Possibly a surgical assistant or resident
Risks and Complications
Common risks include infection, bleeding, and reactions to anesthesia. Rare but serious complications could include injury to adjacent organs, blood clots, and leakage from the colostomy site. Long-term risks may include hernia formation at the colostomy site.
Benefits
- Relieves symptoms and pain associated with the diseased portion of the colon
- Reduces the risk of future infections or obstractions
- Potentially life-saving for conditions like cancer Benefits may be realized shortly after the initial recovery period.
Recovery
- Hospital stay of a few days to a week
- Pain management with medications
- Gradual reintroduction of diet from liquids to solids
- Instructions for colostomy care
- Restrictions on heavy lifting and strenuous activities
- Follow-up appointments for monitoring and possibly planning the reversal of the colostomy if appropriate
Alternatives
- Conservative treatments like antibiotics for diverticulitis
- Chemotherapy and/or radiation for some types of colon cancer
- Other surgical procedures like primary anastomosis (reconnecting the colon without a stoma) Each alternative has its pros and cons related to recovery time, effectiveness, and suitability based on the patient’s condition.
Patient Experience
During the procedure, the patient will be under general anesthesia and feel no pain. Post-procedure, patients may experience discomfort at incision sites, bloating, and difficulty moving. Pain management is addressed with prescribed medications. Gradual improvement in energy levels and reduction in pain will occur over weeks to months.