CPT® Code 43652

A laparoscopic surgical procedure known as vagotomy involves the transection of the vagus nerves, which are critical components of the autonomic nervous system. The vagus nerve, designated as the tenth cranial nerve, originates from the brainstem and extends through the neck, thorax, and abdomen, branching out to innervate various organs, including the stomach and upper digestive tract. The primary purpose of performing a vagotomy is to reduce excessive gastric acid production, thereby aiding in the prevention of peptic ulcers. Historically, vagotomy was a common surgical intervention; however, its frequency has diminished due to the effectiveness of pharmacological treatments available for managing ulcers. During the procedure, a small incision is made in the upper abdomen, through which a trocar is inserted to establish pneumoperitoneum, allowing for the introduction of a laparoscope. Additional incisions are made to facilitate the insertion of surgical instruments. The surgeon carefully identifies the vagus nerve, ensuring it is freed from surrounding tissues. In the context of CPT® Code 43652, a selective or highly selective vagotomy is performed, distinguishing it from a truncal vagotomy, which involves the division of the main vagal trunks. Selective vagotomy entails identifying and dissecting the main vagal trunks up to the branch that leads to the biliary tree, with the goal of transecting the nerve as close to the hepatic branch as possible. Highly selective vagotomy further involves dissection to the Latarjet's nerve branches, which are divided starting at the esophagogastric junction and continuing along the lesser curvature of the stomach. Upon completion of the procedure, the surgical instruments and laparoscope are removed, air is released from the abdominal cavity, and the portal incisions are meticulously closed.