57270 Repair of enterocele, abdominal approach (separate procedure)

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

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: A surgical incision is made in the lower abdomen to access the pelvic cavity.
3. Repositioning: The surgeon repositions the descended small intestines back to their normal location.
4. Reinforcement: Repair involves securing the intestines and often reinforcing the pelvic floor with sutures or mesh.
5. 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.