CPT® Code 43621

The procedure described by CPT® Code 43621 refers to a total gastrectomy with Roux-en-Y reconstruction. This surgical intervention involves the complete removal of the stomach through an upper midline abdominal incision, allowing access to the abdominal cavity. During the procedure, the stomach is carefully mobilized, and clamps are applied to specific anatomical junctions: just above the gastroesophageal junction and just below the gastroduodenal junction. The esophagus is then transected distal to the clamp, and the duodenum is transected proximal to the clamp, resulting in the complete excision of the stomach. Following the gastrectomy, a Roux-en-Y reconstruction is performed, which is a specific type of surgical connection between the esophagus and the small intestine. In this reconstruction, the proximal stump of the duodenum is closed, and a segment of jejunum is mobilized and divided to create a Roux-en-Y limb. This limb is then anastomosed to the side of the esophagus, while the proximal end is connected to the remaining segment of jejunum. This technique is essential for restoring gastrointestinal continuity after the stomach has been removed, allowing for the passage of food from the esophagus to the small intestine while bypassing the stomach.