CPT® Code 45397

Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy, when performed

The CPT® Code 45397 refers to a laparoscopic surgical procedure known as proctectomy, which involves the removal of the rectum and is performed in conjunction with a combined abdominoperineal pull-through procedure. This specific procedure includes the creation of a colonic reservoir, commonly referred to as a J-pouch, and may also involve the establishment of a diverting enterostomy when indicated. The laparoscopic approach utilizes small incisions, typically starting with a portal incision near the umbilicus, through which a trocar is inserted to establish pneumoperitoneum, allowing for the inflation of the abdominal cavity. Additional incisions are made to facilitate the insertion of more trocars, enabling the surgeon to inspect the abdominal cavity thoroughly. During the procedure, the sigmoid colon is mobilized and retracted, and critical structures such as the left ureter are identified and protected. The inferior mesenteric artery and vein are isolated, ligated, and transected to facilitate the removal of the rectum and surrounding mesentery. The rectum is then excised en bloc through a circular incision made in the perineum. Following the removal, a segment of the colon is selected to be fashioned into a reservoir, which is then folded back on itself to create the J-pouch. This pouch is sutured closed and positioned within the pelvis, where it is subsequently anastomosed to the anal mucosa. If a diverting enterostomy is performed, the necessary steps are taken to create a stoma, allowing for the diversion of intestinal contents. This comprehensive procedure is designed to restore bowel continuity and function while minimizing recovery time and complications associated with traditional open surgery.