CPT® Code 45136

The procedure described by CPT® Code 45136 involves the excision of an ileoanal reservoir, which is a surgical intervention performed when complications arise from an existing ileoanal pouch. An ileoanal reservoir, commonly known as an intestinal pouch or J-pouch, is constructed from a segment of the small intestine to serve as a substitute for the rectum after the complete removal of the large intestine (colon) and the rectal lining. This procedure is typically indicated in cases where the ileoanal pouch has developed functional issues or has become infected, leading to conditions such as sepsis. The excision process requires careful surgical techniques, including the creation of a midline abdominal incision to access the abdominal cavity, the lysis of any intra-abdominal and small bowel adhesions, and the meticulous dissection of the ileoanal pouch from the surrounding tissues. The pouch is then detached from the anal mucosa through a perineal approach, allowing for its complete removal from the abdominal cavity. Following this, a second incision is made, often on the right side of the lower abdomen, to facilitate the creation of an ileostomy, where the distal segment of the ileum is brought through the abdominal wall and secured to the skin, allowing for the diversion of stool outside the body.