CPT® Code 47721

1. Indications

The cholecystoenterostomy with gastroenterostomy is indicated for patients experiencing biliary obstruction due to various underlying conditions. The following are specific indications for this procedure:

• Biliary Obstruction - This procedure is performed to alleviate blockages in the bile duct system that prevent normal bile flow.
• Cholecystitis - In cases of inflammation of the gallbladder, this procedure may be necessary to bypass the obstructed area.
• Gallstones - The presence of gallstones that cause obstruction can necessitate this surgical intervention.
• Pancreatic Cancer - Tumors in the pancreas that obstruct the bile duct may require this procedure for relief.
• Other Malignancies - Cancers affecting the biliary system or surrounding structures may also indicate the need for this surgery.

2. Procedure

The procedure for cholecystoenterostomy with gastroenterostomy involves several critical steps, each designed to ensure the successful creation of the necessary connections for bile drainage and gastrointestinal function.

• Step 1: Abdominal Incision - The procedure begins with a midline abdominal incision, which provides access to the abdominal cavity and allows for the mobilization of the gallbladder and a segment of the small intestine.
• Step 2: Exposure and Mobilization - The gallbladder is carefully dissected from its surrounding tissues, and a segment of the small intestine is also mobilized to facilitate the subsequent anastomosis.
• Step 3: Cholecystoenterostomy - A segment of the small intestine is rotated up to the gallbladder and incised longitudinally. The gallbladder is then anastomosed to this segment of the small intestine, allowing bile to drain directly into the intestinal tract.
• Step 4: Gastroenterostomy (if performed) - If a gastroenterostomy is indicated, the stomach and duodenum are divided at the gastroduodenal junction. The opening in the stomach is closed with sutures, and an incision is made along the greater curvature of the stomach. The duodenum is then sutured to the stomach in an end-to-side fashion. Alternatively, a segment of the duodenum or jejunum may be rotated to meet the stomach, with both being incised longitudinally and sutured together in a side-to-side fashion.
• Step 5: Closure - After the anastomoses are completed, the surgical wound is irrigated, and drains are placed as needed. Finally, the abdominal incision is closed in layers to ensure proper healing.

3. Post-Procedure

Post-procedure care for patients who have undergone a cholecystoenterostomy with gastroenterostomy includes monitoring for complications such as infection, leakage from the anastomosis, and ensuring proper recovery of gastrointestinal function. Patients may require a period of hospitalization for observation and management of any postoperative symptoms. Nutritional support may be necessary, and gradual reintroduction of oral intake is typically advised. Follow-up appointments are essential to assess the success of the procedure and to monitor for any long-term complications related to the biliary system or gastrointestinal tract.