CPT® Code 43842

1. Indications

The vertical-banded gastroplasty procedure, represented by CPT® Code 43842, is indicated for patients who are classified as morbidly obese. This condition is typically characterized by a body mass index (BMI) of 40 or greater, or a BMI of 35 or greater with obesity-related comorbidities. The procedure aims to assist in weight loss by restricting food intake and promoting a feeling of fullness, thereby addressing the health risks associated with severe obesity.

• Morbid Obesity Patients with a BMI of 40 or higher, or a BMI of 35 or higher with associated health issues.

2. Procedure

The vertical-banded gastroplasty procedure involves several critical steps to ensure its effectiveness in restricting food intake. Initially, a midline abdominal incision is made to provide access to the stomach. This incision allows the surgeon to visualize and manipulate the stomach effectively. Following this, a small window is created in both the anterior and posterior walls of the stomach at the upper aspect. This step is crucial as it sets the foundation for the formation of the gastric pouch. A line of staples is then placed from the window to the esophagus, which serves to create a small pouch at the upper part of the stomach along the lesser curvature. This pouch is essential for the procedure's goal of limiting food intake. Next, the edges of the windows in the anterior and posterior walls are sutured together, resulting in a through-and-through hole. This hole is where a plastic band is inserted. The band is then wrapped around the lesser curvature of the stomach, positioned just below the newly created gastric pouch. This configuration is designed to create a small outlet from the pouch, which helps to control the passage of food. The presence of the vertical band is significant as it helps to keep food in the pouch longer, thereby enhancing the patient's feeling of fullness after eating. This step is critical in achieving the desired outcomes of weight loss and improved health for the patient.

• Step 1: A midline abdominal incision is made to access the stomach.
• Step 2: A small window is created in both the anterior and posterior walls of the stomach at the upper aspect.
• Step 3: A line of staples is placed from the window to the esophagus to form a small pouch along the lesser curvature.
• Step 4: The edges of the windows are sutured together to create a through-and-through hole.
• Step 5: A plastic band is inserted through the hole and wrapped around the lesser curvature just below the gastric pouch.

3. Post-Procedure

After the vertical-banded gastroplasty procedure, patients typically require careful monitoring and follow-up care to ensure proper recovery and to assess the effectiveness of the surgery. Post-operative care may include dietary modifications to accommodate the new gastric pouch and to promote healing. Patients are often advised to start with liquid diets and gradually progress to soft foods before reintroducing solid foods. It is essential for patients to adhere to the recommended dietary guidelines to avoid complications such as pouch dilation or band slippage. Regular follow-up appointments with healthcare providers are crucial to monitor weight loss progress, nutritional intake, and overall health status following the procedure.