CPT® Code 48540

The procedure described by CPT® Code 48540 involves the internal anastomosis of a pancreatic cyst to the gastrointestinal tract using a Roux-en-Y technique. This surgical intervention is typically indicated for patients with pancreatic cysts that require drainage to alleviate symptoms or prevent complications. The procedure begins with the surgeon making incisions, which can be bilateral subcostal or a midline abdominal incision, to access the cyst. Once the cyst is exposed, fluid is aspirated to confirm that it is indeed a fluid-filled cyst, and this step also allows for the assessment of the cyst wall's thickness. A biopsy may be performed on the cyst wall to exclude the possibility of malignancy. In this specific procedure, the cyst is anastomosed to the jejunum, which is part of the small intestine, through a Roux-en-Y limb. This technique involves mobilizing and dividing the jejunum, creating a Y-shaped configuration that facilitates drainage from the cyst into the gastrointestinal tract. The distal end of the divided jejunum is sutured to the cyst wall, while the proximal end is connected to the jejunum at a point approximately 40 cm away from the distal anastomosis. This method not only allows for effective drainage of the cyst but also minimizes the risk of complications associated with direct anastomosis to the stomach or duodenum. After the anastomosis is completed, drains are placed in the abdominal cavity, and the incision is closed, marking the completion of the procedure.