CPT® Code 43653

The procedure described by CPT® Code 43653 refers to a laparoscopic surgical technique for creating a gastrostomy, which is an opening into the stomach for the purpose of providing nutrition directly. This specific procedure is performed without the construction of a gastric tube, such as in the Stamm procedure, and is classified as a separate procedure. The laparoscopic approach involves making small incisions in the abdomen, allowing for the insertion of a trocar, which is a surgical instrument used to create an entry point into the abdominal cavity. Once pneumoperitoneum, or the inflation of the abdominal cavity with gas, is established, a laparoscope is introduced to visualize the internal structures. The surgeon then makes additional small incisions to insert surgical instruments necessary for the procedure. The stomach is carefully exposed and mobilized to facilitate access. Two concentric purse-string sutures are placed around the intended incision site on the stomach, which helps secure the area for the subsequent steps. The serosa, or outer layer of the stomach, is incised at the center of these sutures, allowing access to the inner mucosal layer. A small portion of this mucosal layer is excised to create an opening, which is then dilated to accommodate a balloon catheter. The balloon catheter is inserted into the stomach, inflated, and positioned against the stomach wall using traction applied to the external catheter. The purse-string sutures are then tied securely around the catheter to maintain its position. The stomach is aligned against the abdominal wall, and the site for the abdominal incision is determined, which may involve using an existing trocar site or creating a new stab incision. The catheter is exteriorized through the abdominal wall, and anchoring sutures are placed on the internal abdominal wall to secure the catheter in place. Finally, the surgical instruments and laparoscope are removed, air is released from the peritoneum, and the portal incisions are closed with sutures, completing the procedure.