CPT® Code 43825

1. Indications

The gastrojejunostomy with vagotomy procedure is indicated for patients suffering from conditions that necessitate a reduction in gastric acid secretion, particularly those with peptic ulcer disease. The following are specific indications for this procedure:

• Peptic Ulcer Disease Patients with recurrent or complicated peptic ulcers that do not respond to medical management may require surgical intervention to reduce acid production and promote healing.
• Gastric Outlet Obstruction This procedure may be indicated in cases where there is a blockage at the outlet of the stomach, preventing normal passage of food into the small intestine.
• Severe Gastritis Patients with severe inflammation of the stomach lining may benefit from this procedure to alleviate symptoms and prevent further complications.

2. Procedure

The gastrojejunostomy with vagotomy involves several detailed procedural steps, which are as follows:

• Step 1: Abdomen Opening The procedure begins with a midline incision in the abdomen, allowing access to the abdominal cavity. The stomach and jejunum are then carefully exposed to facilitate the subsequent steps of the surgery.
• Step 2: Mobilization and Adhesion Lysis Any adhesions that may be present are lysed, and both the stomach and jejunum are mobilized to ensure adequate movement and positioning for the anastomosis.
• Step 3: Retrocolic Technique If a retrocolic technique is employed, the stoma is created as close to the pylorus as possible, at the most dependent portion of the greater curvature of the stomach. Clamps are placed along the greater and lesser curvatures to secure the area for the anastomosis.
• Step 4: Mesocolon Inspection The transverse colon is lifted, and the mesocolon is inspected. The middle colic artery is identified and protected to prevent any vascular complications during the procedure.
• Step 5: Mesentery Incision An avascular segment of mesentery is identified and incised, allowing the stomach to protrude through the incision in the mesocolon. The lesser curvature of the stomach is sutured to the mesocolon to secure the connection.
• Step 6: Jejunal Loop Selection A jejunal loop distal to the ligament of Treitz is selected, clamped, and incised to prepare for the anastomosis with the stomach.
• Step 7: Anastomosis Creation The greater curvature of the stomach is incised, and the jejunum is then sutured to the opening in the stomach in a side-to-side fashion, creating a new pathway for food to pass from the stomach to the jejunum.
• Step 8: Antecolic Technique If an antecolic technique is used, an incision is made in the gastrocolic ligament instead of the mesocolon, and the stomach and jejunum are anastomosed using the same technique as described above.
• Step 9: Wound Closure After the anastomosis is completed, the surgical wound is irrigated, drains are placed as needed, and the abdominal incision is closed in layers to promote proper healing.

3. Post-Procedure

Post-procedure care for patients undergoing gastrojejunostomy with vagotomy includes monitoring for any complications such as infection, bleeding, or anastomotic leaks. Patients are typically advised to follow a specific diet as they recover, gradually transitioning from clear liquids to a more regular diet as tolerated. Pain management is also an important aspect of post-operative care, and patients may require medications to manage discomfort. Follow-up appointments are essential to assess healing and ensure that the anastomosis is functioning properly. Additionally, patients may need to be educated about potential long-term effects of vagotomy, such as changes in gastric emptying and the risk of dumping syndrome.