CPT® Code 44158

Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop ileostomy, and rectal mucosectomy, when performed

The CPT® Code 44158 refers to a surgical procedure known as a total colectomy with proctectomy, which is performed through an abdominal incision. This complex operation involves the complete removal of the colon and rectum, along with the creation of an ileoanal anastomosis and an ileal reservoir, which can take the form of either an S or J pouch. The procedure is designed to allow for the storage and passage of stool in patients who no longer have a functioning large intestine. During the operation, the surgeon mobilizes the entire colon and rectum, carefully dividing and excising the colon between the terminal ileum and the distal rectum. The distal rectum may undergo a mucosectomy, where the mucosal lining is removed while preserving the underlying muscle structure. Subsequently, a segment of the terminal ileum is folded to create a pouch, which is then anastomosed to the anus, facilitating normal stool passage. Additionally, a loop ileostomy may be created, where a portion of the ileum is brought out through the abdominal wall to allow for temporary stool diversion while the anal anastomosis heals. This procedure is typically indicated for various conditions affecting the colon and rectum, providing patients with a functional means of stool elimination post-surgery.