44210 Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy

Name of the Procedure:

Laparoscopy, Surgical; Colectomy, Total, Abdominal, Without Proctectomy, With Ileostomy or Ileoproctostomy

• Common Name: Total Laparoscopic Colectomy
• Medical Terms: Laparoscopic total abdominal colectomy without proctectomy, with ileostomy or ileoproctostomy

Summary

This is a minimally invasive surgery where the entire colon is removed through small incisions in the abdomen. The procedure can result in an ileostomy, where the end of the small intestine is brought through the abdominal wall to create a stoma, or an ileoproctostomy, where the small intestine is attached to the rectum.

Purpose

• Addresses conditions like inflammatory bowel disease (e.g., ulcerative colitis), colorectal cancer, or familial adenomatous polyposis.
• Goals: Remove diseased portions of the colon to alleviate symptoms and prevent complications such as cancer spread.

Indications

• Chronic, severe inflammation of the colon unresponsive to medical treatment.
• Colorectal cancer.
• Genetic conditions predisposed to colon cancer (e.g., familial adenomatous polyposis).
• Severe colonic symptoms affecting quality of life.

Preparation

• Pre-procedure instructions include fasting for several hours and possibly bowel preparation to empty the colon.
• Patients may need to adjust or stop certain medications temporarily.
• Diagnostic tests: Blood tests, colonoscopy, imaging studies like CT scans.

Procedure Description

1. Patient is given general anesthesia.
2. Small incisions are made in the abdomen.
3. A laparoscope (a thin tube with a camera) and surgical instruments are inserted through these incisions.
4. The surgeon carefully removes the entire colon.
5. Depending on the case, an ileostomy or ileoproctostomy is performed.
6. The incisions are closed, and the patient is moved to the recovery area.

Duration

Typically, the procedure takes about 3 to 4 hours.

Setting

Performed in a hospital operating room or surgical center.

Personnel

• Lead by a surgeon specialized in colorectal surgery.
• Assisted by a surgical team, including nurses and surgical technicians.
• Anesthesiologist manages anesthesia and monitors vital signs.

Risks and Complications

• Common risks: Infection, bleeding, blood clots.
• Rare complications: Injury to nearby organs, prolonged ileus (bowel inactivity), hernia at incision sites, and anastomotic leak (if ileoproctostomy is performed).

Benefits

• Relief from symptoms such as pain, bleeding, and inflammation.
• Prevention of disease progression or complications.
• Improved quality of life.

Recovery

• Post-procedure care involves hospital stay for several days.
• Instructions include managing the stoma (if ileostomy), pain management, and wound care.
• Gradual increase in activity levels; dietary adjustments.
• Full recovery can take several weeks; regular follow-up appointments essential.

Alternatives

• Medical management with medications (for inflammatory conditions).
• Partial colectomy (if not all of the colon needs removal).
• Pros: Less invasive.
• Cons: May not be effective long-term or address entire problem.

Patient Experience

• During the procedure: Under general anesthesia, so no awareness or pain.
• After the procedure: Initial discomfort, pain managed with medication.
• Long-term: Adjusting to life with an ileostomy, if applicable; gradual return to normal activities with improved quality of life.