Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, includes rectal mucosectomy, when performed
CPT4 code
Name of the Procedure:
Laparoscopy, Surgical; Colectomy, Total, Abdominal, with Proctectomy, with Ileoanal Anastomosis, Creation of Ileal Reservoir (S or J), with Loop Ileostomy; includes Rectal Mucosectomy, when performed.
Summary
This advanced laparoscopic surgery involves the complete removal of the colon and rectum, creating a new pathway for waste elimination via an ileal reservoir (often shaped like an 'S' or 'J') that is connected to the anus. A temporary loop ileostomy is also constructed to divert stool and allow the new reservoir to heal.
Purpose
This procedure addresses severe diseases of the colon and rectum, such as ulcerative colitis or familial adenomatous polyposis. The goal is to remove diseased tissue while preserving as much bowel function as possible and creating a new functional reservoir for waste elimination.
Indications
- Severe ulcerative colitis
- Unresponsive to medication
- Familial adenomatous polyposis (FAP)
- Colon cancer
Preparation
- Fasting 12 hours before surgery
- Bowel cleansing with prescribed laxatives or enemas
- Discontinuation of certain medications as instructed
- Comprehensive preoperative assessment, including blood tests and imaging studies
Procedure Description
- General anesthesia is administered.
- Small incisions are made in the abdomen for laparoscopic instruments.
- The colon and rectum are detached and removed.
- An ileal reservoir is created from a section of the small intestine.
- The ileal reservoir is connected to the anus (ileoanal anastomosis).
- A temporary loop ileostomy is formed to divert stool.
- Rectal mucosectomy is performed if required.
- Incisions are closed, and sterile dressing is applied.
Duration
The procedure typically takes 4 to 6 hours.
Setting
The procedure is performed in a hospital's operating room.
Personnel
- Surgeon specialized in colorectal surgery
- Surgical nurses
- Anesthesiologist
- Surgical technician
Risks and Complications
- Infection
- Bleeding
- Anastomotic leak
- Ileostomy-related complications
- Bowel obstruction
- Pouchitis (inflammation of the ileal reservoir)
Benefits
- Relief from symptoms of severe colitis or FAP
- Reduced risk of colon cancer
- Improved quality of life post-recovery
Recovery
- Hospital stay of 5 to 7 days
- Gradual return to a normal diet
- Temporary ileostomy care instructions
- Follow-up appointments for ileostomy reversal in about 2 to 3 months
- Full recovery may take several weeks to months
Alternatives
- Medication management of colitis
- Partial colectomy if limited disease
- Permanent ileostomy (without creating an ileal reservoir)
Patient Experience
- General anesthesia will ensure the patient is asleep during the procedure.
- Pain and discomfort post-surgery, managed with pain medication.
- Initial adaptation to ileostomy care and lifestyle changes.
- Progressive improvement in bowel function after ileostomy reversal.