Intraoperative colonic lavage (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Intraoperative Colonic Lavage (IOCL)
Summary
Intraoperative colonic lavage (IOCL) is a medical procedure performed during surgery to clean out the colon. This process involves flushing the colon with a special solution to remove fecal matter and reduce bacterial load. It is commonly done in conjunction with other surgical interventions on the colon.
Purpose
Intraoperative colonic lavage is performed to reduce the risk of infection and complications during and after colorectal surgeries. It aims to ensure a cleaner surgical field and can improve the success rate of the primary procedure.
Indications
- Large bowel obstruction
- Colorectal cancer surgeries
- Diverticulitis requiring surgical intervention
- Non-resolving colonic impactions
Patients who may benefit from the procedure are those undergoing colon surgery where a clean surgical field is crucial for patient safety and procedure efficacy.
Preparation
- Patients are typically required to fast for 8-12 hours before surgery.
- Medications may need adjustment, especially blood thinners and diabetes medications.
- Preoperative evaluations including blood tests, imaging studies, and bowel preparation with laxatives or enemas.
Procedure Description
- Sedation/Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
- Incision: The surgeon makes an incision to access the colon.
- Insertion: A flexible tube is inserted into the colon.
- Flushing: A lavage solution is slowly introduced to flush and clean the colon.
- Collection: Waste material and lavage fluids are collected through the tube.
- Completion: The procedure continues until the desired cleanliness is achieved, after which the primary surgical procedure is completed.
Tools and equipment: Flexible lavage tubes, suction devices, lavage solutions (e.g., saline).
Duration
The intraoperative colonic lavage itself typically takes about 30-60 minutes, but the total surgery time depends on the primary procedure being performed.
Setting
The procedure is conducted in a hospital’s surgical operating room.
Personnel
- Surgeon specialized in colorectal or general surgery
- Anesthesiologist
- Surgical nurses and technicians
- Possibly a gastroenterologist
Risks and Complications
- Infection
- Bowel perforation
- Leakage of lavage fluid into the abdominal cavity
- Anesthesia-related complications
- Electrolyte imbalances
Benefits
- Decreased risk of postoperative infections
- Improved surgical outcomes
- Enhanced visibility and accessibility within the colon for the primary procedure
Recovery
- Post-procedure monitoring in a recovery room
- Gradual reintroduction of oral intake as tolerated
- Pain management with prescribed medication
- Encouraged movement to prevent complications like blood clots
- Follow-up appointments for wound checks and to monitor recovery
Alternatives
- Preoperative bowel preparation with oral laxatives or enemas
- Non-surgical management for certain colorectal conditions
Pros: Preoperative preparations might be less invasive. Cons: May not achieve the same level of colonic cleanliness as intraoperative lavage.
Patient Experience
During the procedure, the patient will be under general anesthesia and won't feel anything. Postoperatively, patients may experience some abdominal discomfort and will be managed with appropriate pain relief measures. Full recovery may take a few weeks, depending on the extent of the surgery and the patient's overall health.