CPT® Code 43108

Total or near total esophagectomy, without thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation and anastomosis(es)

The CPT® Code 43108 refers to a surgical procedure known as a total or near total esophagectomy, which is performed without a thoracotomy (chest incision). This procedure involves the removal of the esophagus and the reconstruction of the digestive tract using either a segment of the colon or small intestine. The term "esophagectomy" specifically denotes the excision of the esophagus, which is the tube that carries food from the throat to the stomach. The reconstruction is achieved through anastomosis, which is the surgical connection of two structures, in this case, the remaining portion of the esophagus or the pharynx to the grafted segment of the colon or small intestine. The procedure is characterized by its complexity and the need for careful mobilization and preparation of the intestinal graft. The choice between using the colon or small intestine for reconstruction depends on various factors, including the patient's anatomy and the extent of the disease affecting the esophagus. The approach used is typically transhiatal, meaning that the surgery is performed through an incision in the upper abdomen rather than through the chest, which helps to minimize complications such as mediastinitis, an infection that can occur following esophageal surgery. During the procedure, the surgeon will explore the peritoneal cavity, mobilize the stomach, and prepare the graft for anastomosis. The careful dissection and preservation of blood vessels are crucial to ensure adequate blood supply to the graft. The overall goal of this procedure is to restore the continuity of the digestive tract while minimizing the risk of complications and ensuring the best possible outcome for the patient.