CPT® Code 43351

Esophagostomy, specifically the procedure described by CPT® Code 43351, involves the surgical creation of a fistula in the esophagus through a thoracic approach. This procedure is primarily performed to facilitate normal eating in patients who may have conditions that obstruct the esophagus or impair its function. The technique entails exteriorizing the proximal (upper) segment of the esophagus, which is brought out through the chest 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, bypassing any obstructions. Following the creation of the stoma, a healing period of approximately two weeks is observed, after which an esophageal tube with a flange is inserted. This tube is designed to remain partially outside the body, connecting to a gastrostomy tube for nutritional support. The thoracic approach typically involves a right posterior thoracotomy, where an incision is made in the skin and extended through the underlying soft tissues to access the thoracic cavity. Care is taken to avoid disrupting the pleura during the procedure, ensuring that the lung is retracted to expose the esophagus adequately for mobilization and division. The surgical technique emphasizes the importance of proper suturing to secure the esophagus to the skin, ensuring that the stoma remains functional for the patient’s nutritional needs.