CPT® Code 43124

Total or partial esophagectomy, without reconstruction, with cervical esophagostomy is a surgical procedure that involves the removal of a portion or the entirety of the esophagus, which is the tube that carries food from the throat to the stomach. This procedure can be performed using various approaches, including cervical, thoracic, or abdominal (transhiatal) methods. In the cervical approach, an incision is made in the neck, typically on the left side, allowing access to the esophagus. The internal jugular vein and carotid artery are carefully identified and retracted to expose the esophagus for surgical intervention. In contrast, the thoracic approach generally involves a right posterior thoracotomy, where an incision is made in the skin and extended through the soft tissues to access the thoracic cavity without disrupting the pleura. This method allows for retropleural dissection and retraction of the lung to expose the esophagus. The abdominal approach requires an incision in the upper abdomen to explore the peritoneal cavity, mobilizing the stomach at the gastroesophageal junction and splitting the diaphragmatic hiatus to access the lower posterior mediastinum and esophagus. Once the esophagus is adequately exposed, the diseased segment is removed, and the proximal and distal stumps are repaired. A cervical esophagostomy is then created, which involves making an incision in the neck if it has not been previously accessed during the esophagectomy. This esophagostomy allows for the placement of a feeding tube, which is essential for nutrition post-surgery. The feeding tube is passed through a tunnel created during the esophagectomy to the distal esophageal stump, where a longitudinal incision is made in the wall of the remaining distal esophageal segment. The feeding tube is then inserted through this incision and into the stomach, and the incision is secured around the feeding tube with a purse-string suture. Finally, the incision in the neck is also closed around the feeding tube, completing the procedure. This complex surgical intervention is typically indicated for patients with esophageal malignancies or other significant lesions affecting the esophagus.