CPT® Code 43846

Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy

The CPT® Code 43846 refers to a gastric restrictive procedure specifically designed for the treatment of morbid obesity. This procedure involves a gastric bypass technique known as Roux-en-Y gastroenterostomy, characterized by a short limb measuring 150 cm or less. The surgical approach begins with an upper abdominal midline incision, which allows access to the stomach. During the operation, the liver is retracted to expose the upper part of the stomach, and the gastroesophageal junction is identified to facilitate the subsequent steps. The gastrohepatic ligament is incised at the lesser curvature of the stomach, creating a tunnel behind the upper stomach. A linear stapler is then employed to transect the stomach, resulting in the formation of a small gastric pouch at the proximal end of the stomach. Following this, the ligament of Treitz is located, and the jejunum is transected a few centimeters distal to this landmark. The procedure continues with the creation of the Roux-en-Y gastroenterostomy, where the distal Roux limb is mobilized and brought up to the newly formed gastric pouch through a tunnel in the transverse mesocolon. The mesenteric defect is subsequently closed around the distal Roux limb. The jejunum is then anastomosed to the small gastric pouch using a side-to-side technique, ensuring that the proximal Roux limb does not exceed the specified length of 150 cm before it is anastomosed to the jejunum. This surgical intervention effectively combines gastric restriction with the bypass of a significant portion of the small intestine, promoting fat malabsorption and aiding in weight loss for individuals suffering from morbid obesity.