45123 Proctectomy, partial, without anastomosis, perineal approach

Name of the Procedure:

Proctectomy, partial, without anastomosis, perineal approach

Summary

A partial proctectomy is a surgical procedure that involves the removal of a part of the rectum. This type of proctectomy does not involve reconnecting the remaining sections of the intestines (no anastomosis) and is performed via the perineal approach, which means the surgery is done through an incision in the perineum (the area between the genitals and the anus).

Purpose

This procedure is primarily performed to address conditions affecting the rectum such as rectal cancer, severe inflammatory bowel disease, or other pathological conditions. The goal is to remove diseased or cancerous tissue to relieve symptoms and prevent further spread of disease.

Indications

• Diagnosis of rectal cancer localized to the lower rectum
• Severe or refractory cases of inflammatory bowel diseases such as ulcerative colitis or Crohn's disease
• Benign but problematic rectal tumors
• Conditions not amenable to conservative treatments

Preparation

• Fasting for a certain period before the procedure, typically starting the night before
• Adjustments to current medications as per physician's advice, such as stopping blood thinners
• Bowel preparation to clean the intestines, often involving laxatives or enemas
• Pre-operative assessments including blood tests, imaging studies, and possibly a colonoscopy

Procedure Description

1. The patient is positioned to allow access to the perineum.
2. Anesthesia is administered, usually general anesthesia.
3. An incision is made in the perineum to access the rectum.
4. The diseased section of the rectum is carefully dissected and removed.
5. Since there is no anastomosis, the remaining rectum is treated as per the planned approach.
6. The incision is then closed with sutures.

Duration

The procedure typically takes about 2-4 hours, depending on the complexity and specific circumstances.

Setting

Usually performed in a hospital or specialized surgical center with appropriate facilities.

Personnel

• Colorectal Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Infection at the site of surgery
• Bleeding
• Injury to nearby organs or structures
• Postoperative pain
• Risk of fecal incontinence
• Possible need for a temporary or permanent colostomy

Benefits

• Removal of diseased or cancerous tissue, leading to potential cure or significant symptom relief
• Reduced risk of disease spread, particularly in cancer cases
• Improvement in quality of life if symptoms are debilitating

Recovery

• Close monitoring in the hospital for a few days post-surgery
• Pain management with medications
• Instructions on wound care and activity restrictions
• Avoiding heavy lifting and strenuous activities for a few weeks
• Follow-up appointments for progress assessment and removal of sutures if necessary

Alternatives

• Total proctectomy with anastomosis or a colostomy
• Non-surgical treatments like chemotherapy or radiation, depending on the condition
• Less invasive surgeries or local excision for smaller lesions

Patient Experience

During the procedure, the patient will be under general anesthesia and not feel anything. Postoperative care involves managing pain with medications and following specific instructions to ensure proper healing. Patients might feel discomfort at the surgical site, and some adjustments in daily activities may be required during the recovery phase.

Pain management is a key component of postoperative care, and options may include oral painkillers or other comfort measures as advised by the healthcare team.