Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy when performed
The physician surgically removes the rectum. The physician makes an abdominal incision, and the distal part of the diseased colon and rectum are mobilized down to the level of the anal sphincter muscles. The rectum is incised at the level of the sphincter muscles while the colon is incised above the pelvic brim where it is disease free. The diseased colon and rectum are removed. The free end of the distal colon is brought through the sphincter complex and approximated with the anus to form a colo-anal anastomosis. The distal colon is folded and sutured in such a way as to create a colonic reservoir pouch. The physician may elect to bring a loop or end of the colon through a separate abdominal incision to create a stoma (enterostomy). The incisions are sutured closed.
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