CPT® Code 43334

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

A paraesophageal hiatal hernia is a specific type of hernia where the gastroesophageal junction remains in its normal anatomical position, but the fundus, which is the upper part of the stomach, protrudes into the thoracic cavity adjacent to the esophagus. This condition can lead to various complications, including obstruction or strangulation of the stomach. The surgical procedure coded as CPT® 43334 involves a repair of this hernia through a thoracotomy, which is an incision made in the chest wall. During the operation, the surgeon mobilizes the stomach and repositions it back into the abdominal cavity. A critical step in this procedure is the creation of a window behind the esophagus, which allows for the proper placement of the stomach. If a fundoplication is indicated, the surgeon wraps the stomach around the esophagus to prevent future reflux and secures it in place with sutures. Techniques such as the Belsey IV or Belsey Mark IV (BMIV) are commonly utilized, which involve a partial wrap of approximately 270 degrees. The hernia sac is carefully excised, and the diaphragm is repaired, either with sutures or reinforced with mesh in a different procedure coded as CPT® 43335. Finally, the thoracic cavity is closed, and chest tubes may be inserted as necessary to facilitate recovery and drainage.