CPT® Code 45400

The procedure described by CPT® Code 45400 refers to a laparoscopic surgical technique known as proctopexy, which is performed to address rectal prolapse. Rectal prolapse occurs when the rectum protrudes through the anus, leading to various complications and discomfort for the patient. This minimally invasive approach involves making small incisions in the abdominal wall, typically near the umbilicus, to insert a trocar, which allows for the introduction of a laparoscope and other surgical instruments into the abdominal cavity. The establishment of pneumoperitoneum, or the inflation of the abdominal cavity with gas, is crucial for providing the surgeon with a clear view and working space. During the procedure, the surgeon inspects the abdominal cavity and carefully dissects the sigmoid colon and rectum from the presacral fascia, which is the connective tissue surrounding the sacrum. This mobilization is essential for accessing the rectum and addressing the prolapse effectively. The presacral space is then entered, allowing for further mobilization of the rectum. The rectal prolapse is reduced, and the segment of the colon that will be secured to the sacrum is identified. In some cases, a portion of the sigmoid colon and upper rectum may be resected to facilitate the reduction of the prolapse. The procedure also involves the interruption of the vascular supply to the affected area, which may include ligating and dividing the inferior mesenteric artery or the individual sigmoid arteries. This step is critical to ensure that the tissue can be safely manipulated and secured without excessive bleeding. The surgeon then transects the sigmoid colon and prepares for anastomosis, which is the surgical connection of the remaining segments of the colon and rectum. The laparoscopic approach allows for a less invasive procedure with potentially quicker recovery times compared to traditional open surgery. Overall, CPT® Code 45400 is utilized when the proctopexy is performed without the need for sigmoid colon resection, providing a targeted solution for rectal prolapse management.