CPT® Code 43112

Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (ie, McKeown esophagectomy or tri-incisional esophagectomy)

A total or near total esophagectomy, with thoracotomy, is a surgical procedure that involves the complete or nearly complete removal of the esophagus, which is the tube that carries food from the throat to the stomach. This procedure is typically performed in cases where there is a need to address severe esophageal conditions, such as cancer or significant damage to the esophagus. The term 'thoracotomy' refers to the surgical incision made in the chest wall to access the thoracic cavity, allowing the surgeon to reach the esophagus effectively. In this context, the procedure may be categorized as a McKeown esophagectomy or a tri-incisional esophagectomy, both of which are specific techniques used to perform the esophagectomy. During the operation, a right posterior thoracotomy is commonly utilized, which involves making an incision on the right side of the back to gain access to the thoracic cavity. The surgical process includes careful dissection to expose the esophagus while preserving critical structures such as the pneumogastric and recurrent nerves, which are essential for normal gastrointestinal function. The procedure also involves the creation of a gastric tube from the stomach, which serves as a new pathway for food to enter the digestive system after the esophagus has been removed. Additional steps may include the ligation and division of specific blood vessels to ensure proper blood supply to the remaining stomach tissue. If necessary, a pyloroplasty may be performed to facilitate the passage of food into the duodenum. Overall, this complex surgical intervention is designed to restore gastrointestinal continuity and function following the removal of the esophagus.