CPT® Code 43400

The procedure described by CPT® Code 43400 refers to the ligation of esophageal varices, which are dilated veins in the esophagus that can lead to significant complications, including life-threatening bleeding. This surgical intervention is typically reserved for patients experiencing variceal bleeding that cannot be managed through less invasive methods such as pharmacologic treatments or endoscopic procedures. The ligation is performed through an open surgical approach, which is not commonly utilized due to the availability of alternative treatment options. In this procedure, the surgeon gains access to the esophagus by performing a right posterolateral thoracotomy, which involves making an incision in the skin and extending it through the underlying soft tissues. The scapula is retracted to facilitate entry into the thoracic cavity while ensuring that the pleura, the membrane surrounding the lungs, remains intact. A retropleural dissection is then carried out, allowing the lung to be retracted and the distal third of the esophagus to be exposed. Alternatively, a transhiatal abdominal approach may be employed, which involves accessing the esophagus through the abdominal cavity. Once the esophagus is adequately exposed, it is dissected free from surrounding tissues, and an incision is made to inspect the varices directly. The varices are subsequently ligated, or tied off, using sutures or bands under direct visualization. After successfully controlling the bleeding from the varices, the esophagus is repaired, and the surgical incisions are closed, marking the completion of the procedure.