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Repair of enterocele, abdominal approach (separate procedure)
CPT4 code
Name of the Procedure:
- Repair of Enterocele, Abdominal Approach
- Medical Term: Enterocele Repair via Laparotomy
Summary
The repair of an enterocele using an abdominal approach involves surgically correcting a condition where a portion of the small intestine descends into the lower pelvic cavity, causing a pelvic hernia. This procedure aims to reposition and secure the affected intestines to prevent further descent and relieve associated symptoms.
Purpose
- Addressing pelvic organ prolapse issues caused by an enterocele.
- Reducing or eliminating symptoms such as pelvic pain, pressure, and bowel dysfunction.
- Restoring normal anatomical positioning of the intestines to prevent recurrence.
Indications
- Chronic pelvic pain or pressure.
- Intestinal prolapse into the vaginal canal.
- Bowel dysfunction attributed to prolapse, such as constipation or incomplete bowel movements.
- Physical examination or imaging confirming the presence of an enterocele.
Preparation
- Fasting: Patients are often required to fast for 8-12 hours before surgery.
- Medication Adjustments: Certain medications, especially blood thinners, may need to be paused.
- Diagnostic Tests: Preoperative imaging (e.g., MRI, CT scan), blood tests, and physical exams are necessary to plan the procedure.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
- Incision: A surgical incision is made in the lower abdomen to access the pelvic cavity.
- Repositioning: The surgeon repositions the descended small intestines back to their normal location.
- Reinforcement: Repair involves securing the intestines and often reinforcing the pelvic floor with sutures or mesh.
- Closure: The abdominal incision is closed with sutures or staples.
Duration
The procedure typically takes about 2-3 hours, depending on the complexity of the case.
Setting
The surgery is performed in a hospital operating room.
Personnel
- Surgeon (usually a general or gynecological surgeon)
- Anesthesiologist
- Surgical nurses and technicians
- Postoperative care team
Risks and Complications
- Common Risks: Infection, bleeding, adverse reactions to anesthesia.
- Rare Risks: Injury to nearby organs (e.g., bladder, bowel), blood clots, hernia recurrence.
- Management: Close monitoring, antibiotics for infection, and addressing complications surgically if necessary.
Benefits
- Relief from pelvic pain and pressure.
- Improved bowel function.
- Restored anatomical integrity of the pelvic cavity.
- Most benefits are typically realized within a few weeks following surgery.
Recovery
- Hospital Stay: Usually involves a 2-4 day hospital stay post-surgery.
- Activity Restriction: Limited physical activity and heavy lifting for 4-6 weeks.
- Pain Management: Pain is managed with prescribed medications and post-operative care.
- Follow-ups: Regular check-ups to monitor recovery progress.
Alternatives
- Pelvic Floor Exercises (e.g., Kegel exercises)
- Pessary device: A non-surgical option to support pelvic organs.
- Other Surgical Approaches: Minimally invasive laparoscopic repair.
- Pros and Cons: Non-surgical options are less invasive but may not provide permanent relief. Laparoscopic approaches may have quicker recovery but may not be suitable for all patients.
Patient Experience
- During: The patient will be under general anesthesia and will not feel any pain.
- After: Some discomfort and pain around the incision site, managed with medications.
- Recovery: Gradual return to normal activities with necessary post-op care instructions, including avoiding strenuous activities and following dietary recommendations. Most patients can resume normal activities within 4-6 weeks with full recovery expected in a few months.