CPT® Code 43335

Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with 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® 43335 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 pulls it back into the chest cavity. A critical step in this procedure is the creation of a window behind the esophagus, which allows for the proper positioning of the stomach. If a fundoplication is indicated, the surgeon wraps the stomach around the esophagus and secures it to the muscle layer, which can help prevent future reflux. Techniques such as the Belsey IV or Belsey Mark IV (BMIV) are commonly utilized, involving a partial 270-degree wrap of the stomach. After the hernia is repaired, the hernia sac is excised, and the diaphragm is either sutured or reinforced with mesh or other prosthetic materials to ensure stability. The thoracic cavity is then closed, and chest tubes may be placed as necessary to facilitate recovery and drainage.