CPT® Code 44136

The procedure described by CPT® Code 44136 refers to intestinal allotransplantation from a living donor. This complex surgical intervention involves the transplantation of a segment of the intestine from a living individual to a recipient who requires this procedure due to severe intestinal dysfunction or failure. The term "allotransplantation" indicates that the donor and recipient are different individuals, which is a critical aspect of this procedure. The operation may include an enterectomy, which is the surgical removal of a portion of the intestine, depending on the specific needs of the recipient. The surgical process begins with an entry into the abdominal cavity, where the surgeon inspects the area for any adhesions that may need to be lysed, or surgically removed. The falciform ligament, which connects the liver to the abdominal wall, is taken down to allow for better access to the liver, which is also inspected during the procedure. The incision is then extended subcostally to the right to facilitate further exploration and manipulation of the abdominal organs. The gallbladder may be resected if necessary, and the cecum is mobilized to prepare for the transplantation. The mesentery, which is the tissue that attaches the intestines to the abdominal wall, is carefully dissected from the retroperitoneal structures to expose critical vascular structures. The inferior vena cava, a major vein that carries deoxygenated blood to the heart, is identified and dissected to the level of the renal vein, followed by the dissection of the superior mesenteric and renal veins, and the infrarenal aorta. This meticulous dissection allows for the placement of arterial and venous grafts on the aorta and inferior vena cava, respectively. The donor intestine is then brought into the operative field, where it is anastomosed, or surgically connected, to the grafts and perfused to ensure adequate blood supply. The native jejunum of the recipient is resected, and the donor intestine is anastomosed both proximally and distally to complete the transplantation. Throughout the procedure, careful attention is given to controlling any bleeding that may occur. Additionally, a gastrostomy tube is placed to provide nutritional support, and the stomach is anchored to the abdominal wall. A jejunostomy tube is also inserted to facilitate further nutritional intake. The donor intestine is exteriorized in the right lower quadrant through a chimney ileostomy, allowing for the management of intestinal output. Finally, drains are placed as needed, and the incisions are closed, with the gastrostomy and jejunostomy tubes secured with sutures to ensure stability and proper healing.