CPT® Code 44188

The procedure described by CPT® Code 44188 refers to a laparoscopic surgical technique used to create a colostomy or skin level cecostomy. This minimally invasive approach involves making a small incision near the umbilicus, through which a trocar is inserted to establish pneumoperitoneum, allowing for the inflation of the abdominal cavity with gas. Additional incisions are made in the upper and lower quadrants of the abdomen to facilitate the insertion of more trocars, which are instruments that allow access to the abdominal cavity for surgical manipulation. During the procedure, the surgeon inspects the abdominal cavity and may encounter adhesions, which are bands of scar tissue that can bind organs together. These adhesions are carefully lysed, or cut, using both blunt and sharp dissection techniques to free the affected areas. The specific segment of the colon or cecum that is to be exteriorized is identified and mobilized, meaning it is carefully detached from surrounding tissues to allow for proper access. A trocar is then placed at the planned stoma site, which is the opening created for the colostomy or cecostomy. The colon or cecum is clamped above and below the site where it will be transected, ensuring that there is no bleeding during the procedure. The stoma site is prepared around the previously placed trocar, and gas is released from the abdomen to facilitate the exteriorization of the colon or cecum through the stoma incision. Once exteriorized, the colon or cecum is transected, and the distal segment is closed with sutures. After removing the clamp, the distal segment is returned to the abdominal cavity, and the proximal clamp is also removed. The proximal segment of the colon or cecum is then everted, meaning it is folded back on itself, and sutured to the skin and subcutaneous tissue to create the stoma. The pneumoperitoneum is re-established to ensure the abdominal cavity is properly inflated, and both the abdomen and the exteriorized bowel segment are inspected to confirm that there is no tension on the stoma, which could lead to complications. Finally, the laparoscope and trocars are removed, the portal incisions are closed, and a stoma appliance is placed to manage the output from the newly created stoma.