CPT® Code 43310

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 or function of the esophagus, such as blunt trauma, avulsion injuries, or complications arising from tracheoesophageal fistulas. The thoracic approach to esophagoplasty generally involves a right posterolateral thoracotomy, which is a surgical incision made in the chest to access the esophagus. During this approach, the skin is incised, and the incision is extended through the underlying soft tissues. The scapula is retracted to allow entry into the thoracic cavity without disrupting the pleura, which is the membrane surrounding the lungs. Once inside, retropleural dissection is performed to retract the lung and expose the esophagus adequately. The mediastinal pleura may be opened as necessary to fully visualize and access the defect in the esophagus. In the context of CPT® Code 43310, the procedure specifically addresses the repair of esophageal defects that do not involve a tracheoesophageal fistula. The surgical team dissects the esophagus free from surrounding tissues to inspect and repair the defect. Any damaged or necrotic tissue within the muscular wall of the esophagus is carefully debrided, and the mucosal defect is exposed. The mucosal tissue is then trimmed back to healthy tissue, inverted, and sutured to facilitate proper healing. A second layer of sutures is applied to the muscular wall of the esophagus to ensure a robust repair. Additionally, the repair may be reinforced using microvascular anastomosis of an intercostal muscle flap, enhancing the structural integrity of the esophagus post-repair.