CPT® Code 37180

1. Indications

The open proximal splenorenal venous anastomosis procedure (CPT® Code 37180) is indicated for the following conditions:

• Portal Hypertension - A condition characterized by increased blood pressure in the portal venous system, often leading to complications such as varices.
• Esophagogastric Varices - Abnormal, enlarged veins in the esophagus and stomach that can rupture and cause significant bleeding.
• Splenic Vein Thrombosis - A blockage of the splenic vein that can lead to complications requiring surgical intervention.

2. Procedure

The procedure for CPT® Code 37180 involves several critical steps to ensure successful venous anastomosis:

• Step 1: Incision - A thoracoabdominal or transabdominal incision is made to provide access to the spleen and surrounding structures. This incision allows the surgeon to visualize and manipulate the splenic vein and left renal vein effectively.
• Step 2: Exposure of the Spleen - The spleen is carefully exposed through the incision. This step is crucial as it allows the surgeon to access the splenic vein for dissection and subsequent anastomosis.
• Step 3: Division of the Splenic Vein - The splenic vein is divided at the splenic porta to maximize the length available for the anastomosis. This ensures that there is sufficient vein length to create a secure connection with the left renal vein.
• Step 4: Removal of the Spleen - The spleen is then removed from the surgical field. This step is necessary to facilitate the dissection of the splenic vein and to prevent any potential complications from the spleen itself.
• Step 5: Dissection of the Splenic Vein - The splenic vein is meticulously dissected free from the pancreatic bed. This involves careful manipulation to avoid damaging surrounding structures.
• Step 6: Ligation of Pancreatic Branches - Small pancreatic branches that drain into the splenic vein are isolated and individually ligated to prevent bleeding during the anastomosis.
• Step 7: Exposure of the Left Renal Vein - The left renal vein is then exposed and isolated, preparing it for the anastomosis with the splenic vein.
• Step 8: Anastomosis - Finally, the end of the splenic vein is anastomosed to the side of the left renal vein. This connection allows for improved venous drainage and alleviates pressure in the portal system.

3. Post-Procedure

After the completion of the open proximal splenorenal venous anastomosis, patients typically require monitoring for any signs of complications, such as bleeding or infection. Post-operative care may include pain management, fluid management, and monitoring of vital signs. Patients are usually advised to follow up with their healthcare provider to assess the success of the procedure and to monitor for any potential complications related to the anastomosis. Recovery time may vary depending on the individual patient's health status and the extent of the surgery performed.