CPT® Code 43333

Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis

A paraesophageal hiatal hernia is a condition where the top 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® 43333 involves a repair of this hernia through a laparotomy, which is a surgical incision into the abdominal cavity. During the procedure, a midline incision is made to access the abdominal organs. The liver is carefully retracted to expose the esophageal hiatus, allowing the surgeon to reduce the herniated stomach back into the abdominal cavity using atraumatic graspers. The procedure also involves the dissection of surrounding structures, including the gastrohepatic ligament and the phrenoesophageal membrane, to adequately access and repair the diaphragm. The hernia sac is mobilized and excised, ensuring that the anterior vagus nerve is protected throughout the process. The diaphragm is then repaired, which may involve suturing or reinforcement with mesh or other prosthetic materials, as indicated by the specific coding. Additionally, a fundoplication may be performed to prevent future reflux, with variations such as the Nissen and Toupet fundoplications providing different methods of wrapping the stomach around the esophagus. This comprehensive approach aims to restore normal anatomy and function while minimizing the risk of recurrence of the hernia.