CPT® Code 43337

Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, 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 described by CPT® Code 43337 involves a repair of this hernia through a combined thoracoabdominal incision, which is particularly indicated for patients who have undergone previous diaphragmatic hernia surgeries or those with hernias that cannot be reduced manually. The approach allows for direct access to both the thoracic and abdominal cavities, facilitating the identification and management of the hernia sac, the diaphragm's muscular origins, and the esophageal hiatus. During the procedure, if a previous fundoplication has been performed, it is carefully taken down to allow for proper repair. The herniated stomach is then mobilized back into the abdominal cavity, and the hernia sac is excised while protecting the anterior vagus nerve. If a fundoplication is indicated, the fundus of the stomach may be wrapped around the esophagus and secured, utilizing various techniques such as Nissen or Toupet procedures. The diaphragm is subsequently repaired, either with sutures or reinforced with mesh or other prosthetic materials, ensuring a robust closure. Finally, the surgical sites in the abdomen and thorax are closed, and chest tubes may be placed as necessary to facilitate recovery.