CPT® Code 45113

Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop ileostomy

The procedure described by CPT® Code 45113 refers to a partial proctectomy combined with rectal mucosectomy, ileoanal anastomosis, and the creation of an ileal reservoir, which can be configured in either an S or J shape. This surgical intervention is typically indicated for patients with conditions affecting the rectum, such as inflammatory bowel disease, rectal cancer, or other significant rectal pathologies that necessitate the removal of a portion of the rectum while preserving anal function. The procedure involves a midline abdominal incision to access the abdominal cavity, allowing for the exploration and identification of the proximal transection site, which may include the sigmoid colon. The mobilization of the sigmoid colon and rectum is crucial for the subsequent steps, which include the placement of clamps to delineate the resection area, division of the rectum, and removal of the diseased segment. The remaining rectal or sigmoid tissue is then sutured to maintain continuity. A key aspect of this procedure is the creation of an ileal reservoir, which serves as a substitute for the rectum, allowing for the storage and passage of stool. Additionally, a loop ileostomy may be established to facilitate stool passage during the healing process of the newly formed pouch and ileoanal anastomosis. This complex surgical procedure aims to restore bowel function while addressing the underlying pathological condition.