Proctectomy; complete, combined abdominoperineal, with colostomy
CPT4 code
Name of the Procedure:
Proctectomy; complete, combined abdominoperineal, with colostomy
Common Names: Abdominoperineal Resection (APR), APR Surgery
Summary
A proctectomy with combined abdominoperineal resection and colostomy is a major surgical procedure where the rectum and part of the colon are removed through incisions in the abdomen and perineum. This surgery also involves creating a colostomy, which is an opening in the abdominal wall for waste elimination.
Purpose
This procedure is primarily done to treat colorectal cancer and other serious rectal diseases. The goal is to remove cancerous tissue or inflamed sections of the bowel and create a new pathway for waste to exit the body through a colostomy.
Indications
- Diagnosed colorectal cancer, particularly when it involves the rectum
- Severe rectal inflammation or infection unresponsive to other treatments
- Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis)
- Other malignant or benign tumors in the rectal area
Preparation
- Fasting for a specified time before surgery
- Bowel preparation to cleanse the intestines
- Preoperative imaging studies and colonoscopy
- Blood tests and medical clearance
- Adjustments to medications as directed, particularly blood thinners
Procedure Description
- Anesthesia: Administered general anesthesia to put the patient to sleep.
- Incisions: Surgical incisions made in the abdomen and perineum.
- Removal: The rectum and part of the sigmoid colon are removed.
- Colostomy: An opening (stoma) is created in the abdominal wall where the end of the remaining colon is attached, allowing fecal matter to collect in an external bag.
- Closure: Incisions are closed with sutures or staples, and a colostomy bag is attached.
Duration
The procedure typically takes about 3-6 hours, depending on complexity and patient condition.
Setting
Performed in a hospital setting, usually in a surgical suite equipped for major operations.
Personnel
- Lead Surgeon (colorectal surgeon)
- Surgical assistants
- Anesthesiologist
- Operating room nurses
- Scrub techs
Risks and Complications
- Infection
- Bleeding
- Anesthesia-related risks
- Damage to nearby organs
- Hernia at the colostomy site
- Postoperative pain and bowel obstruction
- Complications related to colostomy, such as skin irritation
Benefits
- Removal of cancerous or diseased tissue, potentially curing or controlling disease
- Alleviation of symptoms like pain, bleeding, and bowel obstruction
- Improved quality of life with successful management of condition
Recovery
- Hospital stay of around 5-7 days post-surgery
- Pain management with medications
- Gradual return to normal diet
- Instruction on colostomy care and lifestyle adjustments
- Follow-up appointments with the surgical team
- Full recovery may take several weeks to a few months
Alternatives
- Partial proctectomy or less invasive surgical options, depending on the disease stage
- Chemotherapy and radiation therapy
- Palliative care for symptom management without curative intent
- Non-surgical treatments for inflammatory bowel disease
Patient Experience
The patient will be under general anesthesia during the surgery and will not feel anything. Postoperative discomfort is managed with painkillers. They will learn to care for the colostomy and may experience adjustments before returning to daily activities. Emotional and physical support, including potential lifestyle modifications, are important aspects of recovery.