CPT® Code 44155

The CPT® Code 44155 refers to a total colectomy performed through an abdominal approach, which includes the removal of the entire colon along with a proctectomy, and the creation of an ileostomy. This surgical procedure is indicated for various conditions affecting the colon and rectum, such as inflammatory bowel disease, colorectal cancer, or severe diverticulitis. The operation begins with a midline abdominal incision, allowing the surgeon to inspect the abdominal cavity thoroughly. The entire colon is mobilized by detaching it from its peritoneal attachments and separating the omentum from the transverse colon. The mesentery, which contains blood vessels supplying the colon, is carefully divided, starting from the left colon and moving proximally. The ileum, which is the last part of the small intestine, is then divided just before the ileocecal valve, marking the transition from the small intestine to the large intestine. Following the mobilization of the colon, attention shifts to the rectum. The superior rectal vessels are identified, dissected from the sacral promontory, ligated, and divided to ensure proper blood supply management during the procedure. The ureters, which are tubes that carry urine from the kidneys to the bladder, are also identified and protected throughout the surgery. The peritoneum is incised to access the presacral space, where dissection continues down to the pelvic floor. An elliptical incision is made around the anus, allowing for the complete removal of the rectum along with the colon. After the excision, the perineal incision is meticulously closed in layers to promote proper healing. In this procedure, an ileostomy is created, which involves making an incision in the lower abdomen, typically in the right lower quadrant. The terminal end of the ileum is brought through the abdominal wall, folded back on itself, and sutured to the skin and subcutaneous tissue, allowing for the diversion of intestinal contents outside the body. This procedure is significant as it provides a new pathway for waste elimination following the removal of the colon and rectum, ensuring that the patient can maintain a functional digestive system post-surgery.