CPT® Code 44151

The CPT® Code 44151 refers to a total abdominal colectomy performed without proctectomy, accompanied by the creation of a continent ileostomy. This surgical procedure involves a comprehensive approach to remove the entire colon while preserving the rectum. The operation begins with a midline abdominal incision, allowing the surgeon to inspect the abdominal cavity thoroughly. The entire colon is mobilized through the division of lateral peritoneal attachments and the separation of the omentum from the transverse colon. The mesentery, which is the tissue that supports the colon, is carefully divided starting from the left colon and moving proximally. The bowel is then transected at the rectosigmoid junction distally and just above the ileocecal valve proximally, leading to the complete removal of the diseased colon. In this procedure, a continent ileostomy is created, which is a specialized type of ileostomy that allows for the collection of stool in an internal pouch rather than an external bag. A segment of ileum, typically 45 to 60 centimeters in length, is mobilized and folded back on itself to form a reservoir or pouch, which can take the shape of an 'S' or 'J'. This pouch is designed to function as a storage area for fecal matter. The distal segment of the ileum is left approximately 15 centimeters long to create an ileal valve, which helps control the passage of stool. The procedure also involves the use of electrocautery to scarify the segment of ileum just distal to the reservoir, and adjacent mesentery is excised to facilitate the creation of the ileal valve. The final steps include securing the telescoped portion of the ileum to the pouch, suturing the pouch closed, and bringing the distal end of the ileum through the abdominal wall at a stoma site. A large-diameter plastic tube is placed in the stoma to assist with the expansion of the pouch over several weeks. This tube is occluded for progressively longer periods until the patient can tolerate occlusion for up to eight hours, at which point the tube is removed. Post-surgery, the patient is instructed to intubate the pouch through the ileal stoma several times a day to drain fecal matter, ensuring proper management of the newly created internal pouch.