CPT® Code 43123

Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es)

The procedure described by CPT® Code 43123 is a partial esophagectomy, which involves the surgical removal of a portion of the esophagus. This operation can be performed using either a thoracoabdominal or an abdominal approach, and it may include a proximal gastrectomy, which is the removal of the upper part of the stomach. The procedure is characterized by the use of colon interposition or small intestine reconstruction, which entails mobilizing and preparing a segment of the colon or small intestine to create an anastomosis, or surgical connection, to the pharynx or the remaining portion of the esophagus. The choice of using colon or small intestine for reconstruction depends on various factors, including the extent of the esophageal disease and the specific anatomical considerations of the patient. In the thoracoabdominal approach, a median sternotomy is performed, which involves making an incision down the center of the chest and extending it into the upper abdomen. This allows the surgeon to access the esophagus and free it from surrounding tissues. Alternatively, the abdominal (transhiatal) approach may be utilized, where the stomach is mobilized, and the diaphragm is split to expose the lower posterior mediastinum and the esophagus. The esophagus is then transected near the junction with the stomach, and in some cases, a portion of the stomach may also need to be excised to ensure complete removal of any malignancy. The procedure is complex and requires careful planning and execution, particularly when determining the appropriate length of the colon graft needed for reconstruction. The mobilization of the colon or small intestine is critical, as is the preservation of blood supply to ensure the viability of the graft. The final steps involve creating an anastomosis between the thoracic esophagus and the graft, securing the graft in place, and restoring continuity to the remaining colon. A jejunostomy tube is typically placed to facilitate feeding and decompression during the recovery phase.