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Closure of enterostomy, large or small intestine

CPT4 code

Name of the Procedure:

Closure of Enterostomy, Large or Small Intestine

Summary

This procedure involves closing a surgically created opening in the intestine (an enterostomy). This opening, often created during previous surgeries for diverting intestinal contents, is closed to restore normal intestinal function.

Purpose

Closure of an enterostomy addresses the need to restore normal bowel continuity. It is performed to allow the patient to regain typical bowel functions such as proper digestion and excretion.

Indications

  • Patient has a temporary enterostomy due to prior surgery (e.g., to bypass damaged intestinal sections).
  • Adequate healing of the previously affected intestinal segment.
  • Good overall health and ability to withstand surgery.
  • No signs of active infection or significant inflammation in the area.

Preparation

  • Patients may need to fast for 8-12 hours before the surgery.
  • Bowel preparation with a laxative may be required.
  • Medications adjustments or cessation, particularly blood thinners.
  • Pre-procedure diagnostic tests such as blood work, imaging studies, and possibly a colonoscopy to assess bowel health.

Procedure Description

  1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
  2. Incision: A surgical incision is made in the abdomen to access the enterostomy site.
  3. Reconnection: The two ends of the intestine that were separated are identified and cleaned.
  4. Closure: These segments are then sewn back together using sutures or staples to restore continuity.
  5. Inspection: The reconnected intestine is carefully inspected for any signs of leaks.
  6. Closure: The abdominal incision is closed with sutures or staples.

Duration

Typically, the procedure takes about 2-4 hours.

Setting

  • Hospitals (most commonly).
  • Specialized surgical centers.

Personnel

  • Surgeons (specifically gastrointestinal or general surgeons).
  • Anesthesiologists.
  • Surgical nurses.
  • Scrub technicians and operating room staff.

Risks and Complications

  • Infection at the surgical site.
  • Anastomotic leak (leakage where the bowel was reconnected).
  • Bleeding.
  • Bowel obstruction.
  • Postoperative ileus (temporary cessation of bowel activity).

Benefits

  • Restoration of normal bowel function.
  • Improvement in quality of life by eliminating the need for an external ostomy bag.
  • Reduction in the risk of associated complications from long-term enterostomy.

Recovery

  • Hospital stay of about 5-7 days post-procedure.
  • Gradual reintroduction of liquids followed by solids.
  • Pain management with prescribed medications.
  • Possible restrictions on heavy lifting and physical activity for several weeks.
  • Follow-up visits to monitor recovery and ensure proper healing.

Alternatives

  • Continued use of the enterostomy if patient conditions or preferences require.
  • Additional surgeries if simple closure is not feasible (e.g., segmental bowel resection).
  • Endoscopic procedures in specific cases.

Patient Experience

  • Patients typically will not feel anything during the procedure due to general anesthesia.
  • Postoperative pain and discomfort, managed with medications.
  • Some patients may experience temporary digestive issues as their bowel function normalizes.
  • Most regain normal activity levels within 4-6 weeks, following recovery guidelines and restrictions.

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