44345 Revision of colostomy; complicated (reconstruction in-depth) (separate procedure)

Name of the Procedure:

Revision of colostomy; complicated (reconstruction in-depth)

• Commonly referred to as a "complicated colostomy revision" or "in-depth colostomy reconstruction."

Summary

In layman’s terms, this procedure involves surgically correcting or reconstructing a colostomy—a surgically created opening from the colon to the surface of the abdomen that allows for waste to exit the body—in a manner that is more complex than typical revisions.

Purpose

This procedure addresses issues with an existing colostomy, such as blockages, prolapse (when the colostomy protrudes excessively), or other complications. The goals are to restore proper colostomy function, alleviate symptoms, and improve the patient's overall quality of life.

Indications

• Persistent stoma complications like blockage, bleeding, or prolapse.
• Stoma site infections or hernias.
• Poor functional outcome from the initial colostomy.
• Skin irritation or severe discomfort around the stoma site.

Preparation

• Patients may be instructed to fast for a specific period before the surgery.
• Adjustments to medications, especially blood thinners, may be necessary.
• Pre-surgical assessments, including blood tests, imaging studies (like CT scans), and possibly a colonoscopy.

Procedure Description

• The patient is administered general anesthesia.
• Surgeons make an incision around the existing stoma site.
• The damaged or problematic section of the stoma is carefully removed or corrected.
• If needed, sections of the bowel may be reshaped or reconnected to ensure proper function.
• Special surgical tools and techniques are used to create a new stoma or revise the existing one.
• The new colostomy site is secured, and the abdominal incision is closed.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the revision.

Setting

The procedure is performed in a hospital operating room.

Personnel

• A surgical team, including a colorectal or general surgeon.
• An anesthesiologist.
• Operating room nurses and support staff.

Risks and Complications

• Common risks include infection, bleeding, and hernia at the stoma site.
• Rare risks might include injury to surrounding organs or tissues, poor wound healing, or stoma retraction.
• Management of complications may involve medications, additional surgeries, or specialized wound care.

Benefits

• Improved function and comfort of the colostomy.
• Relief from symptoms such as pain, infections, and skin irritation.
• Enhanced quality of life and daily functioning.

Recovery

• Post-procedure care includes pain management, wound care, and monitoring for complications.
• Patients may need to stay in the hospital for several days.
• Gradual return to normal activities over 4 to 6 weeks.
• Follow-up appointments to ensure proper healing and stoma function.

Alternatives

• Non-surgical interventions like stoma appliances or medication adjustments.
• An endoscopic procedure, in some less severe cases.
• Less invasive stoma revision techniques, though these may not be suitable for all patients.

Patient Experience

• Patients might experience discomfort and swelling around the surgical site.
• Pain management will be provided through medication.
• Recovery involves gradually increasing activity and adhering to dietary guidelines.
• Most patients notice a significant improvement in symptoms and overall well-being within a few weeks.