CPT® Code 43644

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)

The CPT® Code 43644 refers to a laparoscopic surgical procedure designed specifically for the treatment of morbid obesity. This procedure involves a gastric restrictive technique combined with a gastric bypass and a Roux-en-Y gastroenterostomy, where the length of the Roux limb is 150 cm or less. The process begins with the creation of a small portal incision in the upper abdomen, through which a trocar is inserted to establish pneumoperitoneum, allowing for the introduction of a laparoscope. Additional portal incisions are made to facilitate the insertion of surgical instruments necessary for the procedure. The surgeon then retracts the liver to expose the upper part of the stomach, identifying key anatomical landmarks such as the gastroesophageal junction. The gastrohepatic ligament is incised to create a tunnel behind the stomach, and an endoscopic linear stapler is employed to transect the stomach, forming a small gastric pouch at its proximal end. Following this, the ligament of Treitz is located, and the jejunum is transected a few centimeters distal to this landmark. The Roux-en-Y gastroenterostomy is performed by mobilizing the distal Roux limb and bringing it up to the newly created gastric pouch through a tunnel in the transverse mesocolon. The mesenteric defect is then closed around the distal Roux limb, and the jejunum is anastomosed to the small gastric pouch using a side-to-side technique. The proximal Roux limb is carefully measured to ensure it does not exceed 150 cm before being anastomosed to the jejunum. This procedure effectively combines gastric restriction with the bypass of a significant portion of the small intestine, promoting fat malabsorption and aiding in weight loss for patients suffering from severe obesity.