CPT® Code 43305

Esophagoplasty is a surgical procedure that involves the plastic repair or reconstruction of the esophagus, which is the muscular tube that connects the throat to the stomach. This procedure is typically indicated for various conditions that may compromise the integrity of the esophagus, such as blunt trauma, avulsion injuries, or the presence of a tracheoesophageal fistula, which is an abnormal connection between the trachea and esophagus. The surgery is performed through a cervical approach, meaning that an incision is made in the neck, usually on the left side, to access the esophagus directly. During the procedure, critical structures such as the internal jugular vein and carotid artery are carefully identified and retracted to provide a clear view of the trachea and esophagus. The surgeon then makes an incision in the cervical esophagus, either above or below the lesion, to facilitate the repair. The esophagus is meticulously dissected from surrounding tissues to allow for thorough inspection and repair of any defects. This may involve debriding any damaged or necrotic tissue and trimming the mucosal tissue until healthy tissue is reached. The mucosal layer is then inverted and sutured, followed by a layered closure of the muscular wall of the esophagus. In cases where a tracheoesophageal fistula is present, as indicated by CPT® Code 43305, the fistula is identified, divided, and the trachea is repaired with sutures. The esophageal defect is closed in layers, and additional support may be provided using pedicle flaps from nearby muscles to reinforce the closure, ensuring a robust repair of the esophagus and trachea.