CPT® Code 44135

The procedure described by CPT® Code 44135 refers to intestinal allotransplantation from a cadaver donor. This complex surgical intervention involves the transplantation of the intestine from a deceased donor into a recipient. The process begins with the physician gaining access to the abdominal cavity, where a thorough inspection is conducted to identify any adhesions that may need to be lysed, or surgically removed. The falciform ligament, which connects the liver to the abdominal wall, is also taken down to allow for better visualization and access to the liver. The surgical incision is then extended subcostally to the right side to expose the gallbladder, which may be resected if necessary. The cecum, a part of the large intestine, is mobilized, and the mesentery, which contains blood vessels and nerves supplying the intestines, is carefully dissected from the retroperitoneal structures. Critical vascular structures, including the inferior vena cava and the superior mesenteric and renal veins, are identified and dissected to facilitate the placement of arterial and venous grafts. These grafts are then attached to the aorta and inferior vena cava, respectively, to ensure proper blood supply to the transplanted intestine. Once the donor intestine is brought into the operative field, it is anastomosed, or surgically connected, to the grafts, and perfused to ensure adequate blood flow. The recipient's native jejunum, a section of the small intestine, is resected to make way for the donor intestine, which is then anastomosed proximally and distally to complete the transplantation process. Throughout the procedure, careful attention is paid to controlling any bleeding that may occur. To support the recipient's nutritional needs post-surgery, a gastrostomy tube is placed, and the stomach is anchored to the abdominal wall. Additionally, a jejunostomy tube is inserted, and the donor intestine is exteriorized in the right lower quadrant, creating a chimney ileostomy. Finally, drains are placed as needed, and the surgical incisions are closed, with the gastrostomy and jejunostomy tubes secured with sutures. This detailed and intricate procedure is essential for patients requiring intestinal transplantation due to various medical conditions.