CPT® Code 44187

The procedure described by CPT® Code 44187 refers to a laparoscopic surgical technique for creating a non-tube ileostomy or jejunostomy. This minimally invasive approach begins with the creation of a small incision near the umbilicus, through which a trocar is inserted to establish pneumoperitoneum, allowing for the inflation of the abdominal cavity with gas. Additional incisions are made in the upper and lower quadrants of the abdomen, where more trocars are placed to facilitate the surgical procedure. The surgeon inspects the abdominal cavity for any abnormalities, such as adhesions, which may need to be lysed using both blunt and sharp dissection techniques. In this specific procedure, the focus is on exteriorizing a segment of the ileum or jejunum without the use of a tube, as opposed to other related procedures that may involve tube placement for feeding or decompression. The surgeon identifies and mobilizes the segment of intestine to be exteriorized, prepares the stoma site, and clamps the intestine above and below the planned transection site. After preparing the stoma site, the jejunum or ileum is exteriorized through the incision, transected, and the distal segment is closed with sutures. The proximal segment is then everted and sutured to the skin and subcutaneous tissue, ensuring a secure stoma. The procedure concludes with the re-establishment of pneumoperitoneum, inspection of the abdominal cavity and the stoma for any tension, removal of the laparoscope and trocars, closure of the incisions, and placement of a stoma appliance to manage output from the newly created stoma.