Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy
CPT4 code
Name of the Procedure:
Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy.
Common name(s): Total Abdominal Colectomy with Proctectomy and Ileostomy, Laparoscopic Total Colectomy.
Summary
This is a minimally invasive surgical procedure to remove the entire colon and rectum (large intestine). The surgeon creates an ileostomy, which is an opening in the abdominal wall for waste to exit the body through the small intestine.
Purpose
This procedure addresses severe bowel diseases, such as ulcerative colitis, Crohn's disease, familial adenomatous polyposis, and certain colorectal cancers. The goal is to remove diseased tissue, prevent disease progression, and improve the patient's quality of life.
Indications
- Chronic ulcerative colitis not responding to medical treatment.
- Severe Crohn's disease affecting the colon and rectum.
- Familial adenomatous polyposis to prevent cancer.
- Colorectal cancer requiring extensive removal.
- Complications like bowel obstruction, perforation, or severe hemorrhage.
Preparation
- Fasting for at least 8 hours before surgery.
- Bowel cleansing with prescribed preparations.
- Pre-operative blood tests, imaging studies, and possibly colonoscopy.
- Stopping certain medications as directed by the physician.
- Meeting with an anesthesiologist for evaluation.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: Small incisions are made in the abdomen to insert laparoscopic instruments.
- Resection: The surgeon removes the entire colon and rectum.
- Ileostomy: An opening is created in the abdominal wall, and the end of the small intestine (ileum) is brought out to form a stoma.
- Closure: The incisions are closed with sutures or staples.
Tools and Equipment:
- Laparoscope with a camera
- Surgical instruments (e.g., graspers, scissors, staplers)
- Anesthesia machine
Duration
The procedure typically takes 3 to 5 hours, depending on complexity.
Setting
Performed in a hospital operating room under sterile conditions.
Personnel
- Surgeon
- Surgical assistants
- Anesthesiologist
- Operating room nurses
Risks and Complications
- Infection
- Bleeding
- Injury to surrounding organs
- Anastomotic leak (leakage where the ileum is stitched to the skin)
- Blood clots
- Postoperative ileus (temporary bowel paralysis)
Benefits
- Relief from symptoms of bowel disease.
- Prevention of disease complications, including cancer.
- Improved quality of life. Improvements can be immediate or over weeks to months.
Recovery
- Hospital stay of 5-7 days.
- Pain management with medications.
- Gradual return to normal diet and activities.
- Stoma care education for managing the ileostomy.
- Follow-up appointments for monitoring.
Alternatives
- Medication management (e.g., anti-inflammatory drugs, immunosuppressants)
- Partial colectomy (removal of part of the colon)
- Endoscopic treatments, if appropriate
Pros and Cons of Alternatives:
- Medications may not be effective long-term and can have side effects.
- Partial colectomy or endoscopy might not address the entire disease.
Patient Experience
- During: The patient is under general anesthesia and feels no pain.
- After: Postoperative pain managed with medications. Discomfort from the stoma initially, but improves with time and proper care. Potential emotional adjustments to living with an ileostomy. Education on stoma care to improve comfort and quality of life.