CPT® Code 44721

1. Indications

The backbench reconstruction of a cadaver or living donor intestine allograft, specifically involving arterial anastomosis, is indicated in various clinical scenarios where intestinal transplantation is deemed necessary. The following conditions may warrant this procedure:

• Intestinal Failure - A condition where the intestines are unable to absorb sufficient nutrients and fluids, leading to malnutrition and dehydration.
• Short Bowel Syndrome - A disorder that occurs when a significant portion of the small intestine is missing or has been removed, resulting in inadequate nutrient absorption.
• Congenital Anomalies - Birth defects affecting the structure of the intestines that may necessitate transplantation for proper function.
• Trauma - Severe injuries to the intestines that compromise their integrity and function, requiring surgical intervention.
• Inflammatory Bowel Disease - Conditions such as Crohn's disease or ulcerative colitis that may lead to extensive intestinal damage and the need for transplantation.

2. Procedure

The procedure for backbench reconstruction involving arterial anastomosis is performed in several detailed steps to ensure the successful preparation of the intestinal allograft for transplantation. Each step is critical to achieving optimal outcomes.

• Step 1: Procurement of the Allograft - The intestinal allograft is harvested from either a cadaver or a living donor. It is crucial that the graft is handled with care to maintain its viability. Once procured, the allograft is placed on ice and bathed in a cold preservation solution to prevent cellular damage.
• Step 2: Preparation of the Arterial Graft - The superior mesenteric artery, which is attached to the intestinal allograft, is identified and prepared for anastomosis. This involves ensuring that the arterial graft is free from any obstructions and is in optimal condition for suturing.
• Step 3: Anastomosis - The arterial anastomosis is performed by suturing the superior mesenteric artery to the extension arterial graft in an end-to-end fashion. This technique is essential for establishing a direct blood supply to the transplanted intestine, which is vital for its function and survival post-transplant.
• Step 4: Additional Grafts - If the surgical team determines that additional arterial extension grafts are necessary to ensure adequate blood flow, each of these grafts will be prepared and anastomosed separately, with each being reported under the appropriate coding guidelines.

3. Post-Procedure

After the completion of the arterial anastomosis, the allograft is carefully monitored for any signs of complications. Post-procedure care includes ensuring that the graft remains viable and that there is adequate blood flow through the newly established anastomosis. The surgical team will typically conduct follow-up assessments to evaluate the function of the allograft and to monitor for any potential rejection or complications. Recovery protocols will be established based on the patient's overall health and the complexity of the transplant procedure, with a focus on optimizing outcomes and minimizing risks.