CPT® Code 43350

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Esophagostomy, specifically the procedure described by CPT® Code 43350, involves the surgical creation of a fistula in the esophagus through an abdominal approach. This procedure is primarily indicated for patients who require an alternative means of nutrition due to conditions that obstruct normal swallowing or esophageal function. The process entails the exteriorization of the proximal (upper) segment of the esophagus, which is brought out through the abdominal wall to form a stoma, while the distal (lower) segment is surgically closed. This stoma allows for the passage of food and fluids directly into the esophagus, facilitating normal eating patterns for the patient. Following the initial surgical intervention, the stoma is allowed to heal for a period of two weeks. After this healing phase, an esophageal tube equipped with a flange is inserted into the stoma. The flange is designed to sit beneath the skin, ensuring that part of the tube remains outside the body, which is then connected to a gastrostomy tube. The procedure is performed using a transhiatal approach, which involves making an incision in the upper abdomen, mobilizing the stomach at the gastroesophageal junction, and splitting the diaphragmatic hiatus to access the lower posterior mediastinum and esophagus. This detailed surgical technique ensures that the esophagus is properly mobilized, divided, and sutured to create a functional stoma for the patient.