Backbench standard preparation of cadaver donor pancreas allograft prior to transplantation, including dissection of allograft from surrounding soft tissues, splenectomy, duodenotomy, ligation of bile duct, ligation of mesenteric vessels, and Y-graft arte
CPT4 code
Name of the Procedure:
Backbench Standard Preparation of Cadaver Donor Pancreas Allograft Prior to Transplantation
Summary
This is a surgical procedure to prepare a donor pancreas for transplantation. It includes dissecting the pancreas from surrounding tissues and performing various vessel ligations and other modifications to ensure the organ is ready for transplant.
Purpose
The primary goal is to prepare the cadaver donor pancreas for successful transplantation into a recipient. This preparation is crucial for the success of the pancreas transplant, which is often performed for patients with severe diabetes or other pancreatic dysfunctions.
Indications
- Patients with type 1 diabetes with severe complications
- Patients with type 2 diabetes who require insulin and have significant comorbidities
- C-peptide negative diabetes patients with end-stage kidney disease
Preparation
- Fasting for at least 8 hours prior to the procedure
- Pre-transplant evaluations including blood tests, imaging studies, and crossmatching
- Adjustment or discontinuation of specific medications as advised by the transplant team
Procedure Description
- Dissection of Allograft: The pancreas is dissected from surrounding soft tissues.
- Splenectomy: Removal of the spleen to reduce the risk of immunological complications.
- Duodenotomy: Cutting into the duodenum to prepare for anastomosis.
- Ligation of Bile Duct: The bile duct is tied off to prevent bile leakage.
- Ligation of Mesenteric Vessels: Tying off the mesenteric vessels to maintain proper blood flow.
- Y-Graft Artery Preparation: Preparing a Y-graft artery for facilitating vascular anastomosis during transplantation.
Tools and equipment include surgical scalpels, clamps, sutures, and specialized vascular instruments. General anesthesia is typically used during the procedure.
Duration
The procedure typically takes 2 to 4 hours.
Setting
Performed in a sterile environment within a hospital operating room.
Personnel
- Transplant Surgeon
- Surgical Nurses
- Anesthesiologist
- Surgical Technicians
Risks and Complications
- Infection
- Blood loss
- Organ damage
- Thrombosis or occlusion of blood vessels
- Anastomosis leakage
Benefits
- Enables successful pancreas transplantation
- Improved glycemic control for diabetic patients
- Potential elimination of insulin dependency
Recovery
- Close monitoring in an ICU immediately following the procedure
- Pain management
- Gradual reintroduction of diet
- Regular follow-up appointments to assess graft function and overall recovery
Alternatives
- Insulin therapy and strict blood sugar control
- Islet cell transplantation
- Continuous glucose monitoring systems
While these alternatives may be less invasive, they may not provide the same potential for curing diabetes as a successful pancreas transplant.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-procedure, the patient may experience some discomfort and pain at the surgical site, which will be managed with medications. The patient's hospital stay typically lasts several days, during which they will be closely monitored for complications.