CPT® Code 32815

The procedure described by CPT® Code 32815 involves the open closure of a major bronchial fistula, which is an abnormal connection between the bronchial tubes and surrounding structures. This surgical intervention is necessary when a fistula, often resulting from conditions such as infection, trauma, or surgical complications, compromises the integrity of the bronchial system. The approach to the fistula is typically through an anterior incision made between the ribs, allowing the surgeon to access the affected area effectively. During the procedure, the pectoralis and intercostal muscles are divided to expose the pleura, the membrane surrounding the lungs. The ribs may be spread apart to provide adequate visibility and access to the fistula. In cases where more extensive exposure is required, the surgeon may opt to split the sternum or remove one or more ribs. Once the fistula is located, it is carefully debrided to remove any necrotic or inflammatory tissue, ensuring a clean site for closure. The closure itself is performed using sutures or staples, and may be reinforced with a local flap of pleura, pericardium, or mediastinal fatty tissue to enhance the repair's strength. In some instances, a vascularized muscle flap may be developed and transposed to cover the bronchial leak site, providing additional support. Alternatively, omentum can be harvested through an abdominal incision and passed through the diaphragm to the fistula site for reinforcement. Following the closure, chest tubes may be placed as necessary to facilitate drainage, and the chest incisions are subsequently closed to complete the procedure.