44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)

Name of the Procedure:

Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis).
Common names: Partial Colectomy, Low Pelvic Anastomosis, Laparoscopic Partial Colectomy

Summary

A partial colectomy performed laparoscopically involves the surgical removal of a portion of the colon. The remaining parts are then reconnected (anastomosed) with a connection made to the rectum (coloproctostomy).

Purpose

• Medical Condition: This procedure addresses conditions such as colorectal cancer, diverticulitis, Crohn’s disease, or severe gastrointestinal bleeding.
• Goals/Expected Outcomes: The primary goal is to remove diseased or damaged sections of the colon and to restore normal bowel function by reattaching the remaining healthy colon to the rectum.

Indications

• Symptoms of persistent pain, bleeding, or obstruction.
• Diagnosed conditions like colorectal cancer, diverticulitis, or inflammatory bowel disease which have not responded to medical treatment.
• Presence of significant polyps that cannot be removed endoscopically.

Preparation

• Pre-procedure Instructions: Patients may be required to fast for several hours before the procedure. A bowel prep to clear the intestines is often mandated.
• Diagnostic Tests: Blood tests, colonoscopy, CT scans, or MRI may be required to assess the extent of the disease.

Procedure Description

1. Anesthesia: Patients receive general anesthesia to be unconscious and pain-free.
2. Incisions: Small incisions are made in the abdomen to insert a laparoscope and other surgical instruments.
3. Colectomy: The diseased portion of the colon is identified, detached from surrounding tissues, and removed.
4. Anastomosis: The two healthy ends of the colon are then connected, along with creating a connection to the rectum.
5. Closure: The small incisions are closed using sutures or staples.

Duration

Typically, the procedure takes about 2 to 3 hours.

Setting

Usually performed in a hospital operating room.

Personnel

• Surgeon: A colorectal or general surgeon typically performs the procedure.
• Anesthesiologist: Manages anesthesia.
• Surgical Team: Nurses and surgical technologists assist during the operation.

Risks and Complications

• Common Risks: Infection, bleeding, adverse reactions to anesthesia.
• Rare Risks: Leakage at the site of anastomosis, injury to surrounding organs, bowel obstruction, blood clots.
• Management: Most complications are managed with medication, additional surgery, or other medical treatments.

Benefits

• Expected Benefits: Relief from symptoms like pain, obstruction, and bleeding. Recovery of normal bowel function.
• Timeframe: Benefits are often realized within weeks after surgery.

Recovery

• Post-procedure Care: Hospital stay of a few days. Diet gradually progressed from liquids to solids.
• Instructions: Care for surgical sites, avoid strenuous activity, and follow a specific diet.
• Recovery Time: Usually 4 to 6 weeks. Regular follow-up appointments are required.

Alternatives

• Non-Surgical Treatments: Medications for inflammation or cancer.
• Minimally Invasive Procedures: Endoscopic polypectomy or stenting.
• Pros and Cons: Alternatives might avoid surgery but may not be as effective in severe cases. Surgery can provide definitive treatment but has associated risks and a longer recovery.

Patient Experience

• During Procedure: The patient is under general anesthesia and will not feel anything.
• After Procedure: Pain managed with medication; discomfort from incisions.
• Pain Management: Medications and supportive care aid in managing post-operative pain.