Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy when performed
CPT4 code
Name of the Procedure:
Proctectomy, Combined Abdominoperineal Pull-Through Procedure
- Commonly known as: Colo-anal Anastomosis, J-Pouch Surgery
- Technical terms: Proctectomy with colo-anal anastomosis and creation of colonic reservoir with diverting enterostomy
Summary
In layman's terms, this surgical procedure removes the rectum and part of the colon. The remaining colon is then pulled through the abdomen and connected to the anus. A reservoir is created from the colon to act as a new storage area for waste, often shaped like the letter "J." A temporary stoma (opening on the abdomen) is also created to divert waste and allow the surgical site to heal.
Purpose
Medical Condition or Problem Addressed:
- Colorectal cancer
- Inflammatory bowel diseases like ulcerative colitis or Crohn's disease
- Familial adenomatous polyposis (FAP)
Goals or Expected Outcomes:
- Remove diseased or cancerous tissue
- Restore bowel function
- Improve quality of life by reducing symptoms such as pain and bleeding
Indications
- Diagnosed colorectal cancer
- Severe, refractory inflammatory bowel disease
- Genetic conditions predisposing to colorectal cancer
- Patients with persistent symptoms not improved by medication
Preparation
- Pre-procedure fasting (typically from midnight before surgery)
- Medication adjustments as directed by the physician
- Bowel preparation to clean out the intestines
- Routine pre-operative tests (blood work, imaging studies, EKG)
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: An incision is made in the abdomen to access the colon and rectum.
- Resection: The rectum and part of the colon are removed.
- Pull-Through: The remaining colon is pulled down and anastomosed (connected) to the anus.
- Colonic Reservoir Creation: A J-pouch is fashioned from the colon to serve as a new rectum.
- Enterostomy: A temporary stoma is created to divert stool and facilitate healing.
- Closure: The incision is closed, and the patient is moved to recovery.
Tools/Equipment Used:
- Surgical instruments
- Anastomosis stapler
- Sutures
- Stoma supplies
Duration
Typically, the procedure takes about 4-6 hours.
Setting
Performed in a hospital setting, often in an operating room equipped for complex surgeries.
Personnel
- Lead Surgeon
- Surgical Assistants
- Anesthesiologist
- Operating Room Nurses
- Surgical Technicians
Risks and Complications
Common Risks:
- Infection
- Bleeding
- Anastomotic leak
- Stoma complications
Rare Risks:
- Deep vein thrombosis (DVT)
- Pulmonary embolism
- Chronic bowel problems
Management of Complications:
- Prompt diagnosis and treatment of infections
- Additional surgeries if necessary
Benefits
Expected Benefits:
- Removal of diseased tissue
- Improved bowel function
- Reduction in symptoms like pain and bleeding Timeframe for Benefits:
- Full benefits typically realized within a few months post-surgery
Recovery
Post-Procedure Care:
- Hospital stay of about 7-10 days
- Pain management
- Gradual reintroduction of diet
- Care of the stoma
Recovery Time:
- Return to normal activities in about 6-8 weeks
- Follow-up appointments for stoma assessment and possible reversal
Alternatives
Other Treatment Options:
- Medical management (medications)
- Partial colectomy
- Endoscopic treatments
Pros and Cons of Alternatives:
- Medical management may not be effective for severe cases
- Partial colectomy may not remove all diseased tissue
- Endoscopic treatments are less invasive but may not be suitable for extensive disease
Patient Experience
During the Procedure:
- Under general anesthesia, so the patient is asleep and feels no pain.
After the Procedure:
- Pain manageable with medication
- Gradual increase in bowel function
- Temporary discomfort from the stoma
- Physical and emotional support important for recovery
Pain Management:
- Use of analgesics and pain management plans customized by the healthcare team