CPT® Code 43855

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The procedure described by CPT® Code 43855 involves the revision of a gastroduodenal anastomosis, specifically a gastroduodenostomy, accompanied by a vagotomy. This surgical intervention is performed when there are complications at the site of a previous anastomosis, which is a surgical connection between the stomach and the duodenum. The abdomen is surgically opened to allow the surgeon to inspect the anastomosis site. Depending on the specific indication for the revision, various techniques may be employed. For instance, if there is a stricture, or narrowing, at the anastomosis site, the surgeon may incise the muscular wall longitudinally to relieve the stricture and then repair it transversely. Alternatively, if a perforation, or hole, is present at the anastomosis site, it can be repaired using sutures. In contrast to CPT® Code 43850, which describes a similar procedure without the vagotomy component, CPT® Code 43855 includes the cutting of the vagus nerve, the tenth cranial nerve responsible for innervating parts of the stomach and upper digestive tract. This step is crucial as it aims to reduce excessive acid production in the stomach, thereby helping to prevent the formation of peptic ulcers. During the procedure, the vagus nerve is carefully identified and separated from surrounding tissues, and the main vagal trunks are divided. After completing the revision and vagotomy, drains may be placed in the abdominal cavity as necessary, and the surgical incision is subsequently closed. This comprehensive approach addresses both the structural issues at the anastomosis site and the physiological factors contributing to complications.