Laparoscopy, surgical; 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:
Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure (e.g., colo-anal anastomosis), with the creation of colonic reservoir (e.g., J-pouch), with diverting enterostomy, when performed.
Summary
This complex surgical procedure, often referred to as a laparoscopic abdominoperineal pull-through with J-pouch creation and diverting enterostomy, involves removing the rectum and creating a new anal passage using a part of the colon. A reservoir is formed to store stool temporarily, and a temporary stoma (opening) is made in the abdomen to divert feces.
Purpose
The procedure is primarily used to treat conditions like colorectal cancer or inflammatory bowel diseases, such as ulcerative colitis, where the rectum needs to be removed. The goal is to eliminate diseased tissue, restore bowel continuity, and maintain as normal bowel function as possible.
Indications
- Colorectal cancer
- Inflammatory bowel diseases (e.g., ulcerative colitis)
- Familial adenomatous polyposis
- Severe rectal prolapse
- Other severe colorectal conditions not responsive to medical management.
Preparation
- Fasting is usually required for at least 8 hours before the procedure.
- Specific bowel prep instructions must be followed to clear the intestines.
- Adjustments to medications, particularly blood thinners and other supplements, as advised by the surgeon.
- Preoperative imaging and diagnostic tests like CT scans, MRIs, or colonoscopies.
Procedure Description
- Under general anesthesia, small incisions are made in the abdomen.
- A laparoscope (a small camera) is inserted to guide the surgery.
- The rectum is removed through these incisions.
- An abdominoperineal pull-through is performed where the colon is pulled down to the anal canal.
- A colonic reservoir (J-pouch) is created by shaping the end of the small intestine.
- A diverting enterostomy (temporary stoma) is formed to divert feces to allow the J-pouch to heal.
Duration
The procedure typically takes 4 to 6 hours.
Setting
The procedure is performed in a hospital's surgical suite.
Personnel
- Colorectal Surgeons
- Surgical Nurses
- Anesthesiologist
- Surgical Assistants
Risks and Complications
- Infection
- Bleeding
- Anesthesia-related complications
- Leakage from the anastomosis (surgical connection)
- Bowel obstruction
- Pouchitis (inflammation in the newly formed pouch)
- Stoma-related issues
Benefits
- Removal of diseased tissue
- Restoration of bowel function
- Potentially curative for cancer or bring symptomatic relief for inflammatory diseases
- Improved quality of life post-recovery.
Recovery
- Hospital stay of 5 to 10 days.
- Gradually resume a normal diet as per medical advice.
- Pain management with medications.
- Avoid heavy lifting and strenuous activities for several weeks.
- Multiple follow-up appointments for stoma care and monitoring of the J-pouch.
Alternatives
- Total proctocolectomy with ileostomy: permanent stoma.
- Medication management for inflammatory bowel disease.
- Radiation and chemotherapy for cancer.
- Less extensive resections for less advanced diseases.
Patient Experience
- General discomfort and pain post-surgery; managed with medications.
- Initial adjustment to living with a temporary stoma.
- Progressive improvement in bowel function as the new reservoir adapts.
- Support from stoma care nurses and nutritional advice for optimal recovery.