CPT® Code 43865

Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; with vagotomy

The procedure described by CPT® Code 43865 involves the revision of a gastrojejunal anastomosis, commonly referred to as gastrojejunostomy, which may include reconstruction with or without partial gastrectomy or intestinal resection, and is performed in conjunction with vagotomy. This surgical intervention is typically indicated when complications arise from a previous gastrojejunostomy, such as strictures or perforations at the anastomosis site. The abdomen is surgically opened to allow for direct inspection of the previous anastomosis. Depending on the specific indication for the revision, the surgeon may perform various corrective actions. For instance, if a stricture is present, it may be released by longitudinally incising the muscular wall and then repairing the stricture transversely. In cases where a perforation is identified, sutures are used to repair the damaged area. The procedure may also involve the excision of a portion of the stomach and/or jejunum, followed by re-anastomosis of the stomach and jejunum. A key aspect of this procedure is the performance of vagotomy, which entails cutting the vagus nerve to reduce excessive acid production in the stomach, thereby helping to prevent the formation of peptic ulcers. The vagus nerve, which is the tenth cranial nerve, plays a significant role in the innervation of the stomach and upper digestive tract. During the procedure, the vagus nerve is carefully identified, freed from surrounding structures, and the main vagal trunks are divided. Post-operative care may include the placement of drains in the abdomen as necessary, followed by the closure of the abdominal incision.