CPT® Code 43331

The procedure described by CPT® Code 43331 is known as esophagomyotomy (Heller type) performed via a thoracic approach. This surgical intervention is primarily indicated for the treatment of esophageal achalasia, a condition characterized by the inability of the esophageal sphincter to relax properly. This dysfunction leads to uncoordinated contractions within the thoracic esophagus, resulting in significant difficulty swallowing (dysphagia) and a functional obstruction of the esophagus. The thoracic approach, typically involving a right posterior thoracotomy, allows for direct access to the esophagus. During the procedure, an incision is made through the skin and extended through the underlying soft tissues, with careful retraction of the scapula to enter the thoracic cavity without damaging the pleura. This approach facilitates retropleural dissection, enabling the surgeon to expose the distal esophagus effectively. The procedure involves making a longitudinal incision in the muscular wall of the distal esophagus, which is then extended down to the gastric cardia, severing all muscle fibers down to the submucosal layer of both the esophagus and stomach. Postoperatively, a nasogastric tube is typically placed to assist with gastric decompression, and if a thoracic approach is utilized, a chest tube may also be inserted to manage any potential pleural effusion. The incisions, whether abdominal or thoracic, are subsequently closed in layers to promote optimal healing.