CPT® Code 44137

The procedure described by CPT® Code 44137 involves the complete removal of a transplanted intestinal allograft. This surgical intervention is typically necessitated by complications such as graft failure, which may occur due to chronic rejection of the transplanted tissue, or other serious issues like thrombosis affecting major arteries. The operation begins with the exposure of the abdominal cavity through a midline incision, allowing the surgeon to access the transplanted intestine and surrounding structures. During the procedure, any adhesions that may have formed are carefully lysed using both blunt and sharp dissection techniques to ensure a clear field of operation. The surgeon then retracts the intestine to expose the aorta, which is critical for identifying and managing the vascular connections made during the initial transplant. The aortic and venous grafts are meticulously dissected and controlled with vessel loops before being clamped and transected. The anastomosis sites, where the transplanted intestine connects to the native intestine, are identified, and the transplanted segment is divided and removed en bloc. Following the removal, the remnants of the aortic and venous grafts are sutured closed, and the distal stump of the native bowel is oversewn to prevent leakage. The proximal end of the native intestine is then exteriorized through a small incision made at the planned enterostomy site. This involves excising fat and opening the anterior rectus fascia to access the peritoneum. An opening of adequate size is created for the stoma, allowing the segment of small bowel to be brought out through the abdominal wall, everted, and sutured to the skin. Additionally, a gastrostomy tube is inserted and anchored to the abdominal wall to facilitate postoperative care. Finally, abdominal drains are placed to manage any potential fluid accumulation, and the surgical wound is closed, completing the procedure.