Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop ileostomy
CPT4 code
Name of the Procedure:
Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop ileostomy.
- Common Name: Partial Proctectomy with Ileoanal Pouch
Summary
A partial proctectomy with ileoanal anastomosis is a surgical procedure involving the removal of part of the rectum, followed by the creation of a new rectal reservoir using a section of the small intestine (shaped like an S or J). This new reservoir is then connected to the anus. A temporary loop ileostomy may be created to divert waste and allow healing.
Purpose
This procedure addresses conditions affecting the rectum that necessitate its removal, such as colorectal cancer, inflammatory bowel disease (e.g., ulcerative colitis), or familial adenomatous polyposis. The goal is to remove diseased tissue, create a functional reservoir for waste, and maintain the patient's ability to pass stool normally.
Indications
- Chronic ulcerative colitis unresponsive to medical treatment
- Colorectal cancer requiring partial rectum removal
- Familial adenomatous polyposis with high risk of cancer
- Severe gastrointestinal functional disorders impacting the rectum
Preparation
- Patient may need to fast for 8-12 hours before surgery.
- Adjustments to medications, particularly blood thinners, may be required.
- Preoperative bowel preparation may be necessary to ensure the bowel is empty.
- Pre-surgical imaging and tests, such as colonoscopy, MRI, or blood tests, to assess the extent of disease and overall health.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: A surgical incision is made in the abdomen.
- Removal of Rectum: The diseased portion of the rectum is removed.
- Mucosectomy: The mucosal lining of the remaining rectum is excised.
- Creation of Ileal Reservoir: A segment of the ileum (small intestine) is folded and shaped into an S or J pouch.
- Ileoanal Anastomosis: The ileal pouch is attached to the anal canal.
- Optional Loop Ileostomy: A temporary ileostomy may be created to divert stool away from the new pouch to allow healing.
- Closure: The incision is closed with sutures or staples.
Duration
The procedure typically takes 4-6 hours.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Lead Surgeon
- Surgical Assistants
- Anesthesiologist
- Operating Room Nurses
- Surgical Technicians
Risks and Complications
- Infection
- Bleeding
- Anastomotic leak (leakage at the connection between the intestine and anal canal)
- Pouchitis (inflammation of the new ileal pouch)
- Intestinal obstruction
- Temporary or permanent bowel dysfunction
Benefits
- Removal of diseased tissue
- Preservation of anal function
- Improved quality of life
- Reduced risk of cancer recurrence (in cases involving cancer)
Recovery
- Initial hospital stay of 5-7 days.
- Pain management with medications.
- Gradual reintroduction of a regular diet.
- Care for possible ileostomy, with specific instructions provided.
- Avoid strenuous activities for several weeks.
- Regular follow-up appointments to monitor recovery and assess pouch function.
Alternatives
- Total Proctocolectomy: Removal of the entire colon and rectum, often with permanent ileostomy.
- Medical management: For conditions like ulcerative colitis, medication, and lifestyle changes may be considered.
- Colectomy with end ileostomy: Removal of colon with external stoma formation, without creating an internal pouch.
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel pain. Post-procedure, patients may experience discomfort and need effective pain management. Adapting to an ileal pouch or temporary ileostomy requires education and support. Recovery involves gradual improvement in bowel function and overall health.