CPT® Code 45123

The procedure described by CPT® Code 45123 is a partial proctectomy performed via a perineal approach, primarily indicated for the treatment of malignant neoplasms located in the rectum. In this surgical intervention, the lower bowel undergoes cleansing through rectal irrigation to prepare for the operation. The technique involves making lateral incisions on both sides of the anus, which are then extended both anteriorly and posteriorly to facilitate access to the rectal area. A critical aspect of this procedure is the closure of the anus using a purse-string suture, which helps to secure the area post-excision. As the surgery progresses, the pudendal vessels are carefully clamped and ligated upon encountering them, ensuring minimal bleeding during the operation. The incision is then advanced posteriorly through the anococcygeal ligament and anteriorly, it is extended proximally behind the prostatic or vaginal fascia. Following this, the rectum is closed below the intended transection site with another purse-string suture, and the rectum is transected above the neoplasm. The levator muscles are divided to allow for the removal of the diseased portion of the colon through the perineal incision. Ultimately, the rectum is divided above the purse-string sutures, and the affected section is excised, with careful control of any bleeding before the incisions are closed. This detailed approach ensures that the malignant tissue is effectively removed while maintaining as much surrounding structure as possible.