44700 Exclusion of small intestine from pelvis by mesh or other prosthesis, or native tissue (eg, bladder or omentum)

Name of the Procedure:

Exclusion of Small Intestine from Pelvis by Mesh or Other Prosthesis, or Native Tissue (e.g., Bladder or Omentum)

Summary

This surgical procedure involves repositioning the small intestine away from the pelvic area using a barrier made of mesh, another prosthetic material, or natural tissues such as the bladder or omentum (a layer of the stomach lining). This helps prevent the intestines from getting trapped or involved in pelvic health issues.

Purpose

The procedure addresses problems related to the small intestine encroaching into the pelvic area, which can cause discomfort, obstruction, or contribute to conditions like hernias. The goal is to effectively separate and protect the small intestine from the pelvis to prevent these complications and achieve an improved quality of life for the patient.

Indications

• Pelvic floor disorders
• Recurrent small bowel obstructions
• Prevention of adhesions in the pelvis
• Patients with a history of hernias or pelvic surgeries
• Conditions like endometriosis affecting the pelvis

Preparation

• Fasting: Patients need to fast for at least 8 hours before surgery.
• Medication Adjustments: Patients may need to stop certain medications, such as blood thinners, based on the surgeon's advice.
• Diagnostic Tests: Imaging studies like CT scans or MRIs to assess the position of the intestine and pelvic anatomy.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia.
2. Incision: A surgical incision is made in the abdominal area.
3. Exposure: The small intestine is located and gently moved away from the pelvic area.
4. Barrier Placement: A barrier, such as surgical mesh or a portion of the omentum, is placed between the small intestine and the pelvis.
5. Securing the Barrier: The barrier is secured in place with sutures or surgical staples.
6. Closure: The abdominal incision is closed with sutures or surgical glue.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity of the case and the materials used.

Setting

The procedure is generally performed in a hospital or a specialized surgical center.

Personnel

• Surgeons: Usually a general surgeon or a specialized gastrointestinal surgeon.
• Nurses: Surgical nurses assist in the operating room.
• Anesthesiologists: Provide and monitor anesthesia.

Risks and Complications

• Common risks include infection, bleeding, and adverse reactions to anesthesia.
• Rare risks include injury to nearby organs, blood clots, and mesh complications such as erosion or migration.

Benefits

• Reduced risk of small bowel obstruction and pelvic adhesions.
• Potential relief from discomfort and improved bowel function.
• The benefits may be realized soon after recovery, usually within a few weeks post-surgery.

Recovery

• Post-Procedure Care: Monitoring in the hospital for 1-2 days, pain management, and gradual return to normal activities.
• Expected Recovery Time: Most patients can return to normal activities within 4 to 6 weeks.
• Restrictions: Avoid heavy lifting and strenuous activity during recovery.
• Follow-Up: Post-operative visits for wound check and to monitor recovery progress.

Alternatives

• Non-surgical options like physical therapy or medications could be tried first.
• Other surgical procedures such as bowel resection or adhesion removal might be considered.
• Each option has its own set of benefits and risks, which should be discussed with a healthcare provider.

Patient Experience

During the procedure, the patient will be under general anesthesia and therefore will not feel anything. Post-operatively, there may be some discomfort and pain at the incision site, which can be managed with prescribed pain medications. Most patients may feel some bloating or mild nausea initially but generally improve within a few days. Comfort measures include pain management and supportive care from the medical team.