CPT® Code 48145

The procedure described by CPT® Code 48145 refers to a distal subtotal pancreatectomy, which may or may not include the removal of the spleen (splenectomy), and involves the creation of a pancreaticojejunostomy. This surgical intervention is performed through a subcostal or midline incision in the abdomen, allowing access to the pancreas and surrounding structures. The procedure begins with the division of the gastrocolic and colosplenic ligaments, which helps in mobilizing the duodenum and the head of the pancreas. The peritoneum is then incised along the inferior border of the pancreas, facilitating blunt dissection to separate the pancreas from the posterior abdominal wall. If the spleen is to be removed, the surgical dissection extends to the hilum of the spleen, where the splenic artery is identified, divided, and ligated to ensure proper removal. The spleen, along with the distal portion of the pancreas, is retracted to expose the inferior mesenteric vein, while the splenic vein is preserved to maintain venous drainage. The mesentery of the uncinate process is also ligated and divided during this process. Once the necessary structures are freed, the body of the pancreas is incised, and a portion of the body along with the entire tail is excised. In cases where the spleen is removed, it is done concurrently with the distal pancreas. Following the resection, a pancreaticojejunostomy is performed, which involves creating a Roux-en-Y jejunal segment. This step is crucial as it establishes a connection between the head of the pancreas and the jejunum, allowing for the drainage of pancreatic secretions into the gastrointestinal tract. The procedure concludes with the closure of the pancreas using interrupted mattress sutures, flushing the wound with normal saline, placing drains, and finally closing the abdominal incision around the drains to promote healing and prevent complications.