CPT® Code 44133

1. Indications

The open donor enterectomy is indicated for specific clinical scenarios where intestinal transplantation is necessary. The following conditions warrant this procedure:

• Irreversible Intestinal Failure - This condition occurs when the intestines can no longer absorb nutrients effectively, leading to severe malnutrition and life-threatening complications.
• Complications from Total Parenteral Nutrition - Patients who rely on long-term total parenteral nutrition may develop complications such as infections, liver dysfunction, or metabolic disorders, necessitating the need for intestinal transplantation.

2. Procedure

The procedure for an open donor enterectomy involves several critical steps to ensure the successful harvesting of the intestinal segment from the living donor. Each step is meticulously performed to maintain the integrity of the organ and its vascular supply.

• Step 1: Incision and Exposure - The abdomen of the living donor is incised in the midline to provide access to the intestines. This approach allows the surgical team to visualize and assess the small intestine thoroughly.
• Step 2: Inspection and Measurement - Once the intestines are exposed, the small intestine is inspected for any abnormalities. The length of the intestine is measured from the ligament of Treitz to the ileocecal valve to determine the appropriate segment for harvesting.
• Step 3: Identification and Marking - The terminal ileum is identified, and a marker is placed approximately 15-20 cm from the ileocecal valve. This marking indicates the proximal aspect of the segment to be harvested, ensuring precision in the surgical excision.
• Step 4: Determining Segment Length - The length of the small bowel segment to be harvested is determined based on the anatomical characteristics of both the transplant recipient and the donor's total intestinal length, ensuring that the segment will be adequate for transplantation.
• Step 5: Dissection of Vascular Structures - The distal aspect of the transplant segment is marked, and the terminal branches of the superior mesenteric artery and vein are carefully dissected from surrounding tissue. These vessels are marked with vessel loops to facilitate identification during the transplant procedure.
• Step 6: Identification of Right Colic Artery - The origin of the right colic artery is identified and marked with a vessel loop, which is crucial for maintaining blood supply to the harvested segment.
• Step 7: Mesenteric Dissection - Mesenteric tissue is dissected to free the intestine from surrounding structures, allowing for a clean excision of the intestinal segment.
• Step 8: Ligation and Division of Vascular Arcades - The vascular arcades are ligated and divided to ensure that the harvested segment has an adequate blood supply for transplantation.
• Step 9: Transection and Transfer - The segment of intestine is then transected and carefully transferred to the recipient surgical suite, where it will be re-anastomosed to the recipient's gastrointestinal tract.

3. Post-Procedure

After the open donor enterectomy, the living donor will require careful monitoring and post-operative care. This includes managing pain, preventing infection, and ensuring proper recovery of the surgical site. The donor may experience some discomfort and will need to follow specific guidelines for activity and diet during the recovery period. The surgical team will provide instructions on follow-up appointments to assess healing and any potential complications. It is essential to ensure that the donor's overall health is maintained, as they have undergone a significant surgical procedure.