CPT® Code 39531

Deleted

Repair, diaphragmatic hernia (esophageal hiatal); combined, thoracoabdominal, with dilation of stricture (with or without gastroplasty)

The procedure described by CPT® Code 39531 involves the surgical repair of a diaphragmatic hernia, specifically an esophageal hiatal hernia, utilizing a combined thoracoabdominal approach. This type of hernia occurs when the esophageal hiatus, the opening in the diaphragm through which the esophagus passes, is abnormally enlarged, allowing a portion of the stomach to protrude into the chest cavity. The combined thoracoabdominal approach is particularly indicated for patients who have previously undergone surgery for a diaphragmatic hernia or for those presenting with an irreducible hernia, which cannot be pushed back into the abdomen. The surgical technique involves both a left posterolateral thoracotomy, which provides access to the esophagus, and an upper abdominal incision, which allows for direct access to the diaphragm and stomach. During the procedure, the surgeon meticulously dissects the tissues in both the upper abdomen and left chest, addressing any adhesions that may be present. The hernia sac is excised, and the anatomical structures, including the muscular origins of the diaphragm and the esophageal hiatus, are carefully identified. If there is a history of prior fundoplication, this is addressed as well. The procedure may also involve dilation of any esophageal strictures present, and if necessary, a gastroplasty is performed to ensure proper anatomical alignment and function. This comprehensive approach aims to restore normal anatomy and function, thereby alleviating symptoms associated with the hernia.