CPT® Code 43281

A paraesophageal hernia is a condition where the stomach's fundus protrudes into the chest cavity while the gastroesophageal junction remains in its normal position. This type of hernia can lead to various complications, including obstruction or strangulation of the stomach. The surgical procedure coded as CPT® 43281 involves a laparoscopic approach to repair this hernia. During the operation, four incisions are made in the upper abdomen to facilitate the insertion of trocars, which are instruments used to create access points for surgical tools. A fifth incision is made above the umbilicus to introduce a laparoscope, allowing the surgeon to visualize the surgical field. The procedure begins with the retraction of the liver to expose the esophageal hiatus, the opening in the diaphragm through which the esophagus passes. The stomach is then carefully reduced back into the abdominal cavity using specialized endoscopic graspers. A clamp is applied to the esophageal fat pad, which is retracted to reveal the gastrohepatic ligament and the phrenoesophageal membrane. The gastrohepatic ligament is incised to expose the right crus of the diaphragm, and dissection is performed to reveal the left crus. This meticulous dissection creates a window behind the esophagus, allowing for the mobilization of the hernia sac and gastroesophageal fat pad while protecting the anterior vagus nerve. Once the hernia sac is removed, the diaphragm is repaired using sutures, and a fundoplication may be performed if necessary. Fundoplication is a technique used to prevent reflux by wrapping the stomach around the esophagus. There are two common variations of this procedure: the Nissen fundoplication, which involves a complete 360-degree wrap, and the Toupet fundoplication, which involves a partial 270-degree wrap. This surgical intervention aims to restore normal anatomy and function, alleviating symptoms associated with the hernia.