# Low anterior resection???



## Amanda_Kentch (Jul 9, 2009)

CAn anyone help?  I do not know what CPT code to use for "Low anterior resection with a diverting loop ileostomy, splaying of incision, and closure of colostomy".  Any help???  Thanks


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## LTibbetts (Jul 9, 2009)

Can you post some of the op note?


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## Amanda_Kentch (Jul 9, 2009)

PROCEDURE:  With the patient in modified lithotomy position, while under general anesthesia, the abdomen was prepped and draped in a sterile fashion. He was explored through a midline incision.  Upon entering the abdomen, adhesions were then encountered, which were carefully dissected down on both sides to get adequate exposure to the pelvis.  With the aid of a Balfour retractor, the small bowel was then mobilized out of the pelvis by dissecting with Metzenbaum scissors as one near along the right pelvic sidewall with some adherence of the small bowel, and after this was then dissected out, though it was not entered into, it was closed over with 2-0 silk suture in a Lembert manner.  Having excellent exposure of the pelvis, the rectal stump was then dissected out. Dissection began on the right side, the right ureter was identified.  The uterus was traced down into the pelvis and the rectal remnant was then dissected along the right side and posteriorly, then the left side was also dissected out.  The left ureter was identified, though not dissected out, and the superior hemorrhoidal vessels were then triply clamped, cut, and tied with 2-0 silk sutures.  The rectum was then mobilized out of the pelvis posteriorly.  There was edema from the radiation that was noted.  Having dissected out posteriorly, then laterally, and then anteriorly along the anterior rectal wall.  Having mobilized the rectum very nicely, a proctoscopy was then performed.  The mass was identified.  The site of dissection was marked and it gaining at least 2 cm distal to the cancer.  The mesorectum was then cleared off with clamping, cutting, and tied with 2-0 silk sutures.  The rectum was then transected with a contour stapler at a desired site that was marked.  Having removed the specimen, the proximal colon was then dissected down by taking down the colostomy make an elliptical incision of the skin, dissecting encounters of subcutaneous tissue, the colon fully mobilized.  The colon was then transected with a Kocher clamp at the stoma margin, and then the descending colon then fully mobilized.  The splenic flexure taken down to gain adequate length for the descending colon to be brought down to the pelvis.  This was done successfully.  The colon is very viable.  The proximal end of the colon was then prepared with a Prolene pursestring suture and a #25 EEA anvil placed in the proximal end of the bowel. An end-to-end anastomosis was then carried out with a descending colon and the rectal stump using the circular #25 EEA stapler.  After this was done, this wasthen tested on the saline, no leak was noted.  A fully fluid  #19 JP drain was then placed in the pelvis.  The rectum was irrigated and suctioned.  The loop of small bowel was then brought up for an ileostomy at the old colostomy site in left lower quadrant, and a loop ileostomy was then brought up and held in place.The abdomen was then inspected.  Sponge and instrument counts were correct.Seprafilm was then placed in the abdomen.  The fascia closed with #1 PDS double-stranded with both ends tied in the middle


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## dfarrow (May 15, 2013)

Cpt 44145 for the distal sigmoid colon or rectum and transverse colon end to end anastomosis with loop ileostomy 44310.


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