CPT® Code 43865

1. Indications

The procedure is indicated for the following conditions:

• Stricture at the Anastomosis Site A narrowing at the site of the previous gastrojejunostomy that may cause obstruction and requires surgical intervention to restore normal passage.
• Perforation at the Anastomosis Site A tear or hole in the anastomosis that can lead to leakage of intestinal contents, necessitating repair to prevent complications such as peritonitis.

2. Procedure

The procedure involves several critical steps to ensure successful revision of the gastrojejunal anastomosis:

• Step 1: Abdominal Opening The surgeon begins by making an incision in the abdomen to access the site of the previous gastrojejunostomy. This allows for direct visualization and assessment of the anastomosis.
• Step 2: Inspection of the Anastomosis Once the abdomen is opened, the surgeon inspects the anastomosis site to identify any complications such as strictures or perforations that require correction.
• Step 3: Release of Stricture If a stricture is found, the surgeon will longitudinally incise the muscular wall at the anastomosis site. This incision helps to relieve the narrowing, and the stricture is then repaired transversely to restore normal function.
• Step 4: Repair of Perforation In cases where a perforation is present, the surgeon will use sutures to close the defect, ensuring that the integrity of the gastrointestinal tract is maintained.
• Step 5: Vagotomy The vagus nerve is identified and freed from surrounding structures. The main vagal trunks are then located and divided to reduce acid production in the stomach, which is crucial for preventing peptic ulcers.
• Step 6: Possible Resection Depending on the findings, a portion of the stomach and/or jejunum may be excised. Following this, the stomach and jejunum are re-anastomosed to restore continuity of the digestive tract.
• Step 7: Drain Placement After completing the necessary revisions and reconstructions, drains may be placed in the abdomen as needed to facilitate fluid management and prevent complications.
• Step 8: Closure of the Abdominal Incision Finally, the abdominal incision is closed in layers to ensure proper healing and minimize the risk of infection.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as infection or leakage at the anastomosis site. Patients may require pain management and will be observed for recovery from anesthesia. The placement of drains, if utilized, will be monitored for output and any signs of obstruction. Dietary modifications may be necessary as the patient begins to resume oral intake, and follow-up appointments will be scheduled to assess healing and function of the gastrointestinal tract.