45111 Proctectomy; partial resection of rectum, transabdominal approach

Name of the Procedure:

Partial Proctectomy (Partial Resection of Rectum, Transabdominal Approach)

Summary

A partial proctectomy is a surgical procedure to remove part of the rectum. It is performed through the abdomen using traditional open surgery or laparoscopy (minimally invasive surgery).

Purpose

Partial proctectomy is used to treat conditions such as rectal cancer, benign rectal polyps, diverticulitis, or inflammatory bowel diseases. The goal is to remove diseased or damaged tissue to alleviate symptoms and prevent further complications.

Indications

• Rectal cancer
• Large benign rectal polyps
• Severe cases of diverticulitis
• Inflammatory bowel disease (such as Crohn's disease or ulcerative colitis)
• Rectal bleeding or obstruction

Preparation

• Patients may be required to fast for 8-12 hours before surgery.
• Bowel preparation with laxatives or enemas may be necessary.
• Routine blood tests, imaging studies (CT scan, MRI), and colonoscopy may be performed.
• Adjustments to medications, including blood thinners, might be necessary.

Procedure Description

1. The patient is given general anesthesia.
2. A catheter is inserted into the bladder.
3. An incision is made in the abdomen, or multiple small incisions are made if using laparoscopy.
4. The surgeon identifies and isolates the part of the rectum to be removed.
5. The diseased portion of the rectum is resected.
6. The remaining ends of the rectum and colon are reconnected (anastomosis).
7. The incision(s) are closed with sutures or staples.
8. Sometimes a temporary stoma (diversion of fecal matter to a bag outside the body) may be created.

Duration

The procedure typically takes 2-4 hours depending on the complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technician

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Anastomotic leak (leakage at the site where the bowel ends are joined)
• Bowel obstruction
• Damage to surrounding organs
• General anesthesia risks

Benefits

• Relief from symptoms such as pain, bleeding, or obstruction.
• Removal of malignant or pre-malignant tissue, which can prevent cancer spread or recurrence.
• Improvement in quality of life.

Recovery

• Hospital stay typically lasts 5-7 days.
• Pain management with medications.
• Patients may have dietary restrictions initially, progressing from liquids to solid foods.
• Instructions on wound care and activity limitations.
• Follow-up appointments to monitor healing and address any complications.
• Full recovery may take several weeks to a few months.

Alternatives

• Non-surgical treatments (e.g., medication, dietary changes) for less severe conditions.
• Endoscopic removal of polyps or early-stage cancers.
• Radiation therapy or chemotherapy for certain types of rectal cancer.
• Pros of alternatives: Less invasive, shorter recovery time.
• Cons of alternatives: May not be curative, less effective for advanced conditions.

Patient Experience

• During the procedure: Patients are under general anesthesia and will not feel any pain.
• After the procedure: Pain and discomfort in the abdomen, managed with pain relief medications.
• Possible use of a temporary stoma, which will require care and management.
• Gradual return to normal activities as recovery progresses.
• Regular follow-up with the healthcare team to ensure optimal healing.