CPT® Code 43113

Total or near total esophagectomy, with thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)

The CPT® Code 43113 refers to a surgical procedure known as a total or near total esophagectomy, which involves the complete or nearly complete removal of the esophagus. This procedure is performed through a thoracotomy, which is an incision made in the chest wall to access the thoracic cavity. Following the esophagectomy, the procedure includes the reconstruction of the esophagus using either a segment of the colon or small intestine. This reconstruction process involves several critical steps, including the mobilization and preparation of the chosen intestinal segment, as well as the creation of an anastomosis, which is a surgical connection between the intestine and the pharynx or the remaining portion of the esophagus. The choice of using colon or small intestine for reconstruction can vary based on the specific clinical scenario and the surgeon's preference. Typically, a right posterior thoracotomy is utilized to gain access to the thoracic cavity. The procedure begins with an incision through the skin and soft tissues, followed by retraction of the scapula to enter the thorax without damaging the pleura. The surgical team performs retropleural dissection to expose the esophagus, while carefully identifying and preserving critical structures such as the pneumogastric and recurrent nerves, as well as the azygous vein and bronchial artery. Once the esophagus is adequately exposed, it is freed from surrounding tissues through both blunt and sharp dissection, and then transected at the esophagogastric junction. The procedure continues with the transection of the pharynx or cervical esophagus, allowing for the complete removal of the esophagus. If a section of colon is selected for the reconstruction, careful dissection is performed to prepare the colon for use as a graft. The procedure is complex and requires meticulous attention to detail to ensure proper anastomosis and restoration of gastrointestinal continuity.