CPT® Code 43312

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 the presence of a tracheoesophageal fistula, which is an abnormal connection between the trachea and the esophagus. The thoracic approach to esophagoplasty generally involves a right posterolateral thoracotomy, where an incision is made in the skin and extended through the underlying soft tissues. The surgical team retracts the scapula to gain access to the thoracic cavity without disrupting the pleura, the membrane surrounding the lungs. Through retropleural dissection, the lung is retracted, allowing for direct exposure of the esophagus. The mediastinal pleura may be opened as necessary to fully visualize and address the defect in the esophagus. In contrast to CPT® Code 43310, which pertains to esophageal defects without a tracheoesophageal fistula, CPT® Code 43312 specifically addresses cases where the esophagoplasty is performed in conjunction with the repair of a tracheoesophageal fistula. During this procedure, the fistula is divided, and the trachea is sutured to restore its integrity. The esophagus is then meticulously repaired in two layers, with the suture line reinforced using a flap of mediastinal pleura, intercostal muscle, and rib periosteum as needed to ensure a robust and effective repair.