44626 Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (eg, closure of Hartmann type procedure)

Name of the Procedure:

Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (e.g., closure of Hartmann type procedure)

Summary

This surgery involves closing a previously created opening (enterostomy) in the small or large intestine and rejoining the separated segments through a procedure known as resection and colorectal anastomosis. It is often referred to as the closure of a Hartmann procedure when it involves reversing a specific type of colostomy.

Purpose

This procedure addresses conditions where a temporary enterostomy was necessary, such as infection, trauma, or cancer. The goal is to restore normal bowel function by reconnecting the intestinal segments.

Indications

• Patients with a temporary colostomy or ileostomy.
• Stable overall health status.
• Well-healed and infection-free surgical site.
• Confirmation that underlying conditions that led to the enterostomy have been resolved.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments might be necessary, especially blood thinners.
• Pre-operative imaging, such as CT scans or colonoscopy.
• Blood tests to ensure overall good health.

Procedure Description

1. General anesthesia is administered.
2. An initial incision is made to access the abdominal cavity.
3. The stoma and any adjoining scar tissue are carefully removed (resection).
4. The ends of the intestine are reconnected (anastomosis).
5. The incisions are closed with sutures or staples.
6. A temporary drainage tube may be placed to remove excess fluids.

Duration

The procedure typically takes about 2 to 4 hours, depending on the complexity.

Setting

This surgery is usually performed in a hospital operating room.

Personnel

• Surgeon specializing in colorectal surgery.
• Anesthesiologist.
• Surgical nurses and technicians.
• Post-operative care team.

Risks and Complications

• Infection at the surgical site.
• Anastomotic leakage where the intestines are rejoined.
• Post-operative ileus (temporary paralysis of the intestine).
• Bleeding or blood clots.
• Risks associated with general anesthesia.

Benefits

• Restoration of normal bowel function.
• Improved quality of life.
• Elimination of the need for an external ostomy bag.
• Recovery of pre-ostomy dietary habits.

Recovery

• Hospital stay of about 5 to 7 days.
• Initial reliance on intravenous fluids, gradually progressing to a regular diet.
• Pain management through prescribed medications.
• Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor healing.

Alternatives

• Continued use of the enterostomy with appropriate care.
• Alternative surgical techniques depending on the patient’s condition.
• Non-surgical management of underlying conditions, if possible.

Patient Experience

Patients can expect to experience some pain and discomfort post-surgery, managed through medication. Some temporary difficulties in bowel movements may occur as the body adapts. Emotional and psychological support may be beneficial during recovery.

Pain management will be closely monitored, and comfort measures such as proper positioning and gentle mobilization will be encouraged to facilitate recovery.