CPT® Code 48146

A distal near-total pancreatectomy, also known as a Child-type procedure, involves the surgical removal of the majority of the pancreas while preserving the duodenum. This procedure is characterized by the excision of approximately 95% of the pancreas, specifically targeting the body and tail, while ensuring that the duodenum remains intact. The operation typically begins with a subcostal or midline incision in the abdomen, allowing access to the abdominal cavity. During the procedure, the gastrocolic and colosplenic ligaments are divided to facilitate the mobilization of the duodenum and the head of the pancreas. The surgical team carefully incises the peritoneum along the inferior border of the pancreas to perform blunt dissection, which helps free the pancreas from the posterior abdominal wall. The spleen is also dissected free and retracted to provide visibility of the inferior mesenteric vein. The procedure requires meticulous attention to the preservation of blood vessels that supply the duodenum, ensuring that the patient maintains adequate blood flow post-surgery. The pancreatic duct is identified, and drainage to the duodenum is confirmed before the pancreas is sutured closed. Finally, the surgical site is flushed with normal saline, drains are placed, and the abdomen is closed around these drains to promote healing and prevent complications.