CPT® Code 48160

1. Indications

The procedure described by CPT® Code 48160 is indicated for various conditions that may necessitate the removal of pancreatic tissue, followed by transplantation. The following are explicitly provided indications for this procedure:

• Severe Pancreatitis - Chronic or acute pancreatitis that has not responded to conservative management may require surgical intervention.
• Pancreatic Tumors - The presence of benign or malignant tumors in the pancreas may necessitate partial or total pancreatectomy.
• Pancreatic Insufficiency - Conditions leading to significant loss of pancreatic function may warrant removal and subsequent transplantation to restore some pancreatic function.

2. Procedure

The procedure for CPT® Code 48160 involves several critical steps, each essential for the successful execution of the pancreatectomy and transplantation:

• Step 1: Incision - A subcostal or midline incision is made in the abdomen to provide access to the pancreas. This incision allows the surgeon to navigate the abdominal cavity effectively.
• Step 2: Division of Gastrocolic Omentum - The gastrocolic omentum is divided to enter the lesser sac, which is a space behind the stomach that provides access to the pancreas.
• Step 3: Mobilization of Flexures - The splenic and hepatic flexures of the colon are mobilized to create more space and improve visibility of the pancreas during the procedure.
• Step 4: Dissection of Attachments - Attachments between the posterior stomach and pancreas are divided, allowing for better access to the pancreas itself.
• Step 5: Exposure of the Pancreas - The stomach is elevated to expose the anterior surface of the pancreas, facilitating the next steps of the procedure.
• Step 6: Incision of Peritoneum - The peritoneum along the inferior border of the pancreas is incised, and the body and tail of the pancreas are mobilized for removal.
• Step 7: Division of Ligaments and Arteries - The mobilization of the tail of the pancreas requires the division of the splenic ligaments and short gastric arteries (vasa brevia) to ensure complete removal.
• Step 8: Removal of the Pancreas - The pancreas is dissected from the mesenteric vessels, and depending on the specific case, all or part of the pancreas is removed.
• Step 9: Autotransplantation - If autotransplantation is indicated, pancreatic tissue is harvested and prepared for transplantation, often into nearby bowel.
• Step 10: Islet Cell Extraction - If an islet cell transplant is performed, a collagenase solution is injected into the resected pancreas to separate the islet cells from the acinar tissue. The islet cells are then collected, washed, and diluted in plasma.
• Step 11: Transplantation of Islet Cells - The prepared islet cell tissue is injected into the portal vein of the liver or transplanted beneath the kidneys, depending on the surgical plan.
• Step 12: Closure - Finally, the abdomen is closed around drains to facilitate postoperative recovery and monitoring.

3. Post-Procedure

Post-procedure care following a pancreatectomy with autologous transplantation involves monitoring the patient for complications such as bleeding, infection, or issues related to the transplanted tissue. Patients may require close observation in a hospital setting for several days following the surgery. Recovery may involve managing pain and ensuring proper nutrition, as the removal of pancreatic tissue can affect digestion. Follow-up appointments are essential to assess the function of the transplanted islet cells and to monitor the patient's overall health and recovery progress.