CPT® Code 45110

The procedure described by CPT® Code 45110 refers to a complete proctectomy, specifically a combined abdominoperineal resection, which is performed with the creation of a colostomy. This surgical intervention involves the removal of the rectum and a portion of the sigmoid colon, necessitating a midline incision in the abdomen to access the internal structures. During the operation, the surgeon identifies the proximal transection site, which may involve the sigmoid colon, and mobilizes both the sigmoid colon and rectum. A clamp is applied above the planned transection site to control blood flow. The procedure continues with an incision made in the perineum, where the outer layer of the rectal wall is divided in a circular manner. This allows for the rectum and its surrounding mesentery to be detached from their pelvic and abdominal attachments, enabling the entire structure to be removed en bloc through the perineal incision. After the rectum is excised, the perineal incision is closed, and the anal mucosa is sutured. A separate incision is then created to establish a stoma, through which the proximal segment of the colon is exteriorized. The colon is everted and sutured to the skin and subcutaneous tissue to secure the stoma. Finally, drains are placed in the abdominal cavity, the abdominal incision is closed, and a stoma appliance is applied to manage waste. This comprehensive procedure is typically indicated for conditions such as rectal cancer or severe inflammatory bowel disease, where removal of the rectum is necessary for patient health and well-being.