CPT® Code 43845

Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)

The CPT® Code 43845 refers to a complex surgical procedure known as a gastric restrictive procedure with partial gastrectomy, specifically designed to limit nutrient absorption. This procedure is commonly recognized as biliopancreatic diversion with duodenal switch. It involves significant alterations to the gastrointestinal tract to aid in weight loss and manage obesity-related health issues. The procedure begins with a midline abdominal incision, which allows the surgeon to access the stomach and surrounding structures. The stomach is then mobilized, and a longitudinal pouch is created through a staple division that starts at the top of the gastric fundus and extends laterally to the gastroesophageal junction at the angle of His. This step is crucial as it reduces the stomach's capacity, thereby limiting food intake. In this procedure, the lateral aspect of the stomach is removed, while the pyloric sphincter and a small portion of the proximal duodenum are preserved to maintain some normal digestive function. The first portion of the duodenum is carefully mobilized and transected a few centimeters from the pylorus, which is essential for the subsequent steps. The small bowel is also transected at a specific distance from the ileocecal valve, allowing for the creation of a new pathway for food and digestive juices. The distal limb of the small bowel is then sutured to the remaining duodenal segment using an end-to-end technique, which facilitates the flow of digestive contents. Finally, the proximal biliopancreatic limb is connected to the small bowel at a calculated distance from the ileocecal valve, typically between 50 to 100 cm, to optimize nutrient absorption. After the completion of these steps, drains are placed to manage any potential fluid accumulation, and the abdominal incisions are meticulously closed to promote healing.