CPT® Code 45120

Proctectomy, complete (for congenital megacolon), abdominal and perineal approach; with pull-through procedure and anastomosis (eg, Swenson, Duhamel, or Soave type operation)

The procedure described by CPT® Code 45120 is known as a complete proctectomy, specifically performed for congenital megacolon, which is also referred to as Hirschsprung's disease. This condition is characterized by the absence of ganglion cells, a specialized type of nerve cell, in the rectum and potentially extending into varying lengths of the colon. The absence of these nerve cells results from a failure during fetal development, where the ganglion cells do not migrate along the bowel, leading to significant functional abnormalities. Patients with congenital megacolon may experience a range of symptoms, from complete bowel obstruction to severe constipation, necessitating surgical intervention. The surgical approach for this procedure involves both abdominal and perineal access. A midline incision is made in the abdomen to allow for exploration and identification of the affected bowel segments. The surgical technique includes the removal of the abnormal bowel segments, which are then replaced with segments of normal bowel that contain the necessary nerve cells. This is achieved by pulling down a healthy segment of bowel and connecting it to the anal mucosa, thereby restoring normal bowel function. The procedure may also be referred to by specific names such as the Swenson, Duhamel, or Soave operation, which are variations of the technique used to perform the anastomosis between the remaining bowel and the anal area. The goal of this surgery is to alleviate the symptoms associated with congenital megacolon and to improve the patient's quality of life by restoring normal bowel function.