CPT® Code 43640

The procedure described by CPT® Code 43640 involves a surgical intervention known as vagotomy, which is the cutting of the vagus nerve, specifically aimed at reducing excessive acid production in the stomach. The vagus nerve, the tenth cranial nerve, plays a crucial role in the autonomic regulation of the digestive system, influencing gastric secretions and motility. By performing a vagotomy, surgeons aim to alleviate conditions such as peptic ulcers that are exacerbated by high levels of stomach acid. The procedure can be categorized into truncal or selective vagotomy, depending on the extent of nerve division. A midline upper abdominal incision is utilized to access the stomach and the vagus nerve, allowing the surgeon to identify and isolate the nerve from surrounding tissues. In truncal vagotomy, the main trunks of the vagus nerve are severed, while in selective vagotomy, the procedure is more targeted, preserving certain branches that innervate the biliary tree. To mitigate the effects of vagotomy on gastric motility, a pyloroplasty is performed, which involves enlarging the opening between the stomach and the duodenum. Additionally, a gastrostomy may be performed to create an opening in the stomach for feeding purposes. This comprehensive approach addresses both the underlying issue of acid production and the functional implications of the surgery on gastric emptying.