CPT® Code 43332

Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other prosthesis

A paraesophageal hiatal hernia is a condition where the upper part of the stomach, known as the fundus, protrudes into the chest cavity alongside the esophagus 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® 43332 involves a laparotomy, which is a surgical incision into the abdominal cavity, to repair this hernia. During the operation, a midline incision is made to access the abdominal cavity, allowing the surgeon to retract the liver and expose the esophageal hiatus, the opening in the diaphragm through which the esophagus passes. The herniated stomach is carefully repositioned back into the abdomen using atraumatic graspers to minimize tissue damage. The procedure may also involve incising the gastrohepatic ligament and exposing the diaphragm's crura, which are the muscular structures that support the esophagus. The hernia sac is mobilized and excised, and the diaphragm is repaired, ensuring that the anatomical structures are restored to their proper positions. This procedure may also include a fundoplication, which is a technique used to prevent gastroesophageal reflux, with variations such as the Nissen and Toupet fundoplications being common options. The Nissen fundoplication involves a complete wrap of the stomach around the esophagus, while the Toupet fundoplication involves a partial wrap. The CPT® 43332 code specifically refers to the repair of the hernia without the use of mesh or other prosthetic materials, distinguishing it from similar procedures that may involve such implants.