CPT® Code 44207

The procedure described by CPT® Code 44207 refers to a laparoscopic surgical technique for performing a partial colectomy with anastomosis, specifically involving a coloproctostomy, which is a low pelvic anastomosis. This minimally invasive approach begins with the creation of 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 used to access the abdominal cavity. The surgeon inspects the abdominal cavity and identifies the superior rectal vessels, which are then carefully dissected from the sacral promontory, ligated, and divided to prepare for the resection of the rectum. The rectum is mobilized from its proximal to mid and distal aspects, allowing for the distal resection to be performed using an endoscopic linear stapler or cutter. The mesorectum, which is the fatty tissue surrounding the rectum, is also divided during this process. The segment of colon that is to be resected is mobilized to enable its exteriorization through an enlarged incision at one of the lower abdominal trocar sites. The divided end of the rectosigmoid colon is then brought through this incision, allowing the bowel to be exteriorized beyond the proximal resection site. The proximal resection site is identified and resected using clips and a harmonic scalpel, which is a device that uses ultrasonic vibrations to cut and coagulate tissue simultaneously. After placing a purse-string suture and anvil around the end of the remaining bowel, the exteriorized bowel is returned to the abdominal cavity, and the incision is closed. A stapler is then passed through the anus, with its spike advanced out through the rectal stump. The stapler and anvil are mated, and the stapler is fired to create an end-to-end anastomosis between the rectal stump and the colon. This procedure is designed to restore continuity of the gastrointestinal tract following the resection of the affected colon segment, ensuring that the patient can maintain normal bowel function post-surgery.